AccountId: 011433970860
ContactId: 9e17a232-ad65-4db8-9128-85bb450b5db3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 654750 ms
Total Talk Time (AGENT): 217468 ms
Total Talk Time (CUSTOMER): 360743 ms
Interruptions: 5
Overall Sentiment: AGENT=1.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/9e17a232-ad65-4db8-9128-85bb450b5db3_20250428T19:57_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII] calling for Doctor uh [PII] to check on a claim, uh, clarification. Please be informed that this call is being recorded and monitored for quality and training purposes. May I know if I, if I can help you with the patient's information or provider's information?
[AGENT][NEUTRAL] OK, so first off, would you please, did you say your name is [PII]? Is that correct?
[CUSTOMER][POSITIVE] Yes, perfect. Yes, right.
[AGENT][NEUTRAL] OK, thank you. And what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and you have one member that you're needing claim status on, is that correct?
[CUSTOMER][NEUTRAL] Yes, right.
[AGENT][NEUTRAL] OK. Yes, I can help you with that, [PII]. And what is the member's policy number?
[CUSTOMER][NEUTRAL] Uh, it is 01832260. M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] OK, thank you. Give me a moment please log in to get the member's information pulled up.
[CUSTOMER][POSITIVE] Yeah, sure. Take your time.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information that I do provide for you, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is uh [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. What is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Date of service here is [PII] and the bill amount is $779 779.
[AGENT][NEUTRAL] And you said the year is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Perfect. Yes.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah, sure. Take your time. [PII], your name is spell it as [PII], right?
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Actually, I spell it [PII]
[AGENT][NEUTRAL] It's an [PII] at the end. Uh, you're welcome, and you will use my name along with today's date, [PII], as your call reference number.
[CUSTOMER][POSITIVE] OK, thank you very much.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, thank you very much, [PII].
[AGENT][POSITIVE] Uh, you're welcome.
[CUSTOMER][NEUTRAL] OK uh date of birth.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so give me just a moment, [PII], to look through the claims to list if I can locate one for your billed amount.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] It
[CUSTOMER][POSITIVE] OK, no problem. Take your time.
[AGENT][POSITIVE] Thank you. Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so actually, [PII], I do not have a claim on file for this member for data service 818-2022 for $779.
[CUSTOMER][NEUTRAL] it.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Let's get.
[CUSTOMER][POSITIVE] OK, uh, thank you very much, [PII], for this information.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK, let me reconfirm. I have checked for the updated one. Just a moment.
[CUSTOMER][NEUTRAL] Checking for the details. Is there any different bill amount? Just a moment for that.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] OK, thank you very much, [PII]. I really appreciate your patience. OK.
[AGENT][POSITIVE] Oh, you're welcome.
[CUSTOMER][NEUTRAL] OK, just a moment. The system is loading.
[AGENT][NEUTRAL] Mhm. Sure.
[CUSTOMER][NEUTRAL] OK, the bill amount mentioned here is $662 even.
[CUSTOMER][NEUTRAL] I have.
[AGENT][NEUTRAL] 662. Is that correct?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, right.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] OK, just a moment. Let me see if we have that one on file for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK I'm planning to give me a good.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so this claim for that bill amount for the 662 was received.
[CUSTOMER][NEUTRAL] OK. May I know the received date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, I beg your pardon?
[AGENT][NEUTRAL] Processed and denied on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, but the latest submitted claim, recently submitted claim is on, uh, [PII]. Do you have the claim on file?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, [PII], recently submitted. Do you have that account?
[AGENT][NEUTRAL] No, sir.
[AGENT][NEUTRAL] Mm. No, sir.
[CUSTOMER][NEUTRAL] OK, uh, I, OK, thank you very much, [PII], for checking. I have a claim number here. Could you please check on the basis of claim number?
[AGENT][NEUTRAL] What is the claim number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It is 202208-256713129.
[AGENT][NEUTRAL] OK, that is not an APO claim number. I don't know whose claim number that is, but, um, that is not our company's claim number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Thank you very much, [PII]. So the claim is not on file, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. May I know the effective, uh, sorry, the patient is active in data service.
[AGENT][NEUTRAL] This policy was active from [PII].
[CUSTOMER][NEUTRAL] Uh [PII] and term date is uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Well
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, [PII]. Thank you. And we just verify the claim number. Just a moment. I have to mention the same here verified claim number.
[AGENT][NEUTRAL] Again, that long, that very long claim number that you gave me is not our company's claim number.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you very much. 35 number. OK. And you are a primary or secondary insurance for this member?
[AGENT][NEUTRAL] This would have been a supplement to the primary insurance?
[CUSTOMER][NEUTRAL] So you're a secondary insurance for this member, right?
[AGENT][NEUTRAL] Yes, sir. We're not a major medical insurance company. We were the supplement. Mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK. OK, so you are supplement, uh, so it is treated as a secondary, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Thank you very much. I had to mention the same here, you're a secondary insurance.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Thank you. and preferred mode of claim submission is?
[AGENT][NEUTRAL] I'm so sorry, what was the last, what was?
[CUSTOMER][NEUTRAL] Electronically or by mail?
[CUSTOMER][NEUTRAL] Yeah, uh, may I know the preferred mode of claim submission? It is by electronically or by mail or both?
[AGENT][NEUTRAL] They, but you can do both, but we do have to have a copy of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK, so the preferred mode of submission is by both electronically or by mail, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And the claim submission family filing is?
[CUSTOMER][NEUTRAL] Yeah the name H5.
[AGENT][NEGATIVE] No timely filings.
[CUSTOMER][NEUTRAL] OK, so no claim submissions on the filing. Thank you very much, [PII]. I had a mission the same here.
[CUSTOMER][NEUTRAL] So, OK. May I know claim submission mailing address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, let me just reconfirm your [PII], right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] May I know the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Maybe.
[CUSTOMER][NEUTRAL] OK, 60801 and the conference number is uh your name and to this date, right?
[AGENT][NEUTRAL] My
[AGENT][NEUTRAL] That is correct. And then also, um,
[AGENT][NEUTRAL] If once you file the claim, if you, if you do end up submitting a claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this was an initial claim status. Is that correct?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, OK. So we do have a portal, Logan, that you should be able to check claim status in by going to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, thank you very much for this information, [PII].
[AGENT][POSITIVE] Yes, sir. You're welcome. Is there anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, thank you very much, [PII] for your assistance. Have a great day. Take care bye bye.
[AGENT][POSITIVE] Well, you're, well, I hope you have a great day too, and thank you again for calling APL if that is all I can help you with today.
[CUSTOMER][POSITIVE] OK, thank you very much.
[AGENT][POSITIVE] Uh-huh, bye bye. You're welcome.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Alright.