AccountId: 011433970860
ContactId: 9fc21381-1300-4e39-b332-ce7a1f679806
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 755849 ms
Total Talk Time (AGENT): 227981 ms
Total Talk Time (CUSTOMER): 196239 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/9fc21381-1300-4e39-b332-ce7a1f679806_20250618T19:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] from provider's office. I'm looking for claims.
[AGENT][NEUTRAL] OK, I can check on a claim for you. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] Era is Yankee Uniform [PII].
[AGENT][POSITIVE] OK, thank you for that. um can I get a good call back number uh from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] is the extension [PII].
[AGENT][NEUTRAL] OK, thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] Yes, it's 01930681 M as in Mike L as in Lima number 8.
[AGENT][NEUTRAL] OK and uh what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] It's for [PII].
[CUSTOMER][NEUTRAL] And the birthday is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That was [PII] and uh what was that bill amount please?
[CUSTOMER][NEUTRAL] $747 and even.
[AGENT][NEUTRAL] 747.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then do you have the uh tax ID for this provider?
[CUSTOMER][NEUTRAL] Yes, I do have here the tax ID [PII].
[AGENT][NEUTRAL] OK thank you one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, uh, so I only have one claim on file for the state of service from that provider is for the amount of $39.71. Was that the amount after major medical paid?
[CUSTOMER][POSITIVE] Wow
[CUSTOMER][NEUTRAL] Um, sorry, one second, can you repeat that?
[AGENT][NEUTRAL] Sure, so the one claim that I have on file for the state of service was for the amount of $39.71. Was that the remaining balance after major medical paid?
[CUSTOMER][NEUTRAL] OK, but I do have here the
[CUSTOMER][NEUTRAL] But the amount is $747 and the remaining balance is $136.34. It's for the date of service [PII]. Am I right? Are you checking for?
[AGENT][NEUTRAL] Yes, that's what I'm looking at currently um so if that's a different one then it does not appear that we've received that claim.
[CUSTOMER][NEUTRAL] OK. And may I verify the patient policy effective date and the termination date?
[AGENT][NEUTRAL] Yes, the effective date was [PII].
[AGENT][NEUTRAL] And it is currently active.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII] and still lasting, OK. And may I know the
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mailing address to submit the claim.
[AGENT][NEUTRAL] Yes, uh, that is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah, I got it. We have submitted the claim to the valid address but it wasn't received it. OK, there is any pay ID?
[AGENT][NEUTRAL] Her ID is 60801.
[CUSTOMER][NEUTRAL] OK, and when are the timely filing limit?
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][NEUTRAL] There is no time limit to resubmit the claim, am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Once I move to the next number with the call reference number.
[AGENT][NEUTRAL] The reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII]
[CUSTOMER][NEUTRAL] Can you spell your first name?
[AGENT][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] And you said that there were other claims we needed to look at?
[CUSTOMER][POSITIVE] Yeah, thank you for that.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, um, give me that was for a different policy number, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, uh, if you'll give me one moment, I'll let you know and I'm ready to proceed with that next policy number.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] OK, I appreciate your patience. You can go ahead and give me that next uh policy number.
[CUSTOMER][NEUTRAL] Yes, and the next policy number is 018.
[CUSTOMER][NEUTRAL] 94931 M as in Mike. L as in Lima number 8.
[AGENT][NEUTRAL] OK and uh what was the name and date of birth for this number please?
[CUSTOMER][NEUTRAL] Yes, and the name and the date of birth is [PII].
[CUSTOMER][NEUTRAL] Birthja and the birthday is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. What was the date of service for this claim, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and then, uh, what was that bill amount please?
[CUSTOMER][NEUTRAL] $345 and even.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm sorry, you did say that was for $345 even correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Was that the amount before or after major medical paid?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Was that the amount before or after major medical paid?
[CUSTOMER][NEUTRAL] Paid, am I right?
[AGENT][NEUTRAL] After major medical paid, is that the remaining balance?
[CUSTOMER][NEUTRAL] No, I have here there is the the claim bill for 345 and the remaining balance is $192.43.
[AGENT][POSITIVE] Got it. OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] OK, so we did receive this claim and we did pay that benefit of $192.43.
[AGENT][NEUTRAL] Did you need that claim number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, may I have the claim number?
[AGENT][NEUTRAL] That is 34.
[AGENT][NEUTRAL] 91445.
[CUSTOMER][NEUTRAL] OK OK and when are the claim review date and the date?
[AGENT][NEUTRAL] This claim was received [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] And we know the allowed amount on the paid amount is the same.
[AGENT][NEUTRAL] Yes, uh, it was a single check of $192.43.
[CUSTOMER][NEUTRAL] $192.43.
[CUSTOMER][NEUTRAL] And we know the mode of the payment?
[AGENT][NEUTRAL] Uh, it was a, a paper check. I've got that check number for you whenever you're ready.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] That is 18.
[AGENT][NEUTRAL] 67.
[AGENT][NEUTRAL] 630.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And another one was the tech course you done cleared.
[AGENT][NEUTRAL] This check was issued on [PII].
[AGENT][NEUTRAL] And it did clear on [PII].
[CUSTOMER][NEUTRAL] And may I know the
[CUSTOMER][NEUTRAL] Bulk, you take it for the single check or a bulk check?
[AGENT][NEUTRAL] Single check.
[CUSTOMER][NEGATIVE] I don't think it's OK.
[CUSTOMER][NEUTRAL] Can you send me the copy of the EOB through my fax number?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Sure, what was that fax number for you?
[CUSTOMER][NEUTRAL] 646
[CUSTOMER][NEUTRAL] 736
[CUSTOMER][NEUTRAL] 5011.
[AGENT][NEUTRAL] OK, I'm gonna read that back to make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Yes, and I know how many days you need uh, when will you receive the EOB?
[AGENT][POSITIVE] Um, I'm gonna go ahead and send it now. You should get it within about 10 minutes or so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][POSITIVE] OK, well thank you for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][POSITIVE] Thank you, bye bye.