AccountId: 011433970860
ContactId: a6bf4ec4-7765-4593-bde8-4c2ef2646e26
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1252719 ms
Total Talk Time (AGENT): 351861 ms
Total Talk Time (CUSTOMER): 492678 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/a6bf4ec4-7765-4593-bde8-4c2ef2646e26_20250311T13:39_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from the provider's office to check on a claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status and from my notes, can you spell your first name for me, please, and provide a contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, it's [PII], and the callback number is [PII].
[AGENT][NEUTRAL] [PII] is the phone number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it's 02458642. M as in Mike, L as in Lime 8.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] The member's last name is [PII] and the member's first name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] It's $125.
[AGENT][NEUTRAL] $125?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. The providers of uh is B E R N H A R D T and it's laboratory.
[AGENT][NEUTRAL] What's the tax ID?
[CUSTOMER][NEUTRAL] Just a moment. I will provide you.
[CUSTOMER][NEUTRAL] The tax ID, the tax ID is [PII].
[AGENT][NEUTRAL] OK, so this is a different tax ID. Hold on one moment.
[CUSTOMER][NEUTRAL] They do.
[AGENT][NEUTRAL] OK, there's only one claim on file that totals $125 but it's a different provider with a different tax ID.
[AGENT][NEUTRAL] Um, so I'm gonna have to say there's no claim on file for your provider because it's a different tax ID.
[CUSTOMER][NEUTRAL] Just a moment. Claim is not on file.
[CUSTOMER][NEUTRAL] May I know the effect due date?
[AGENT][NEUTRAL] Yes, the policy has been effective since [PII].
[CUSTOMER][NEUTRAL] OK. And what is the term date?
[AGENT][NEUTRAL] The policy, hold on one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Termed on [PII].
[CUSTOMER][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] And what is the timely filing limit?
[AGENT][NEUTRAL] There's no timely filing as long as the policy was active on the data service, you can file at any time.
[CUSTOMER][NEUTRAL] OK. May I know the uh claim mailing address?
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mailbox.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm. So [PII] [PII].
[CUSTOMER][NEUTRAL] Can you spell out that word?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it's [PII]
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The zip code is [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, may I know the payer ID?
[AGENT][NEUTRAL] Sure, it's 60801.
[CUSTOMER][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK. Can you spell out your name?
[AGENT][NEUTRAL] Sure, my name is [PII] The [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm having, having another one claim. Give me the status of that claim.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I'm having another claim.
[CUSTOMER][NEUTRAL] Provide me the status.
[AGENT][NEUTRAL] You have another claim, OK, and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] It's uh
[CUSTOMER][NEUTRAL] Total, I was having 5 claims from that one claim has been resolved.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] It's 1433462. M as in Mike, L as in Lime 7.
[AGENT][NEUTRAL] Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's, the last name is [PII] and the first name is [PII] And the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII] and the bill amount is $174.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yes, it's Global Pathology Laboratory Service.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, hold on, because this, this, this claim has the same provider as the last claim, but this is not the provider you're giving. So,
[AGENT][NEUTRAL] Is there any other name or tax ID that this can come up under?
[CUSTOMER][NEUTRAL] Can I give you the tax ID of this provider?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So this provider is different than the last provider, right? Because it's saying it's coming up as the same thing. I just want to make sure because the last claim had the correct total and a different provider name.
[AGENT][NEUTRAL] And tax ID.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Even this is like claim is not on file?
[AGENT][NEUTRAL] No, no, it's OK. Hold on one second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] So I'm showing received the claim on [PII].
[CUSTOMER][NEUTRAL] Just a moment. I want to write.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Received on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Claim number is 356.
[AGENT][NEUTRAL] 63
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] 356-663
[AGENT][NEUTRAL] 92
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 92.
[CUSTOMER][NEUTRAL] OK. Process on?
[AGENT][NEUTRAL] And on [PII]
[AGENT][NEUTRAL] On [PII], the claim was denied.
[AGENT][NEUTRAL] Because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, processed all.
[CUSTOMER][NEUTRAL] 29.
[CUSTOMER][NEUTRAL] Services are not covered?
[AGENT][NEUTRAL] When performed in a doctor's office or clinic?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Doctors.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, the services are not covered by the doctor's office or or the clinic. Am I correct?
[AGENT][NEUTRAL] It's not, it's not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] It means that the services are not covered uh by this policy. Am I correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Just a moment. OK. I'm uh I will give another claim number, member's ID.
[AGENT][NEUTRAL] OK, is this the last claim for this member?
[CUSTOMER][NEUTRAL] No, I told like uh there was 5 claims and from that 2 claims I.
[AGENT][NEUTRAL] Do you have any
[AGENT][NEUTRAL] Do you have any other claims for [PII]?
[CUSTOMER][NEGATIVE] No, no, no.
[AGENT][NEUTRAL] OK, thank you, hold on one moment.
[CUSTOMER][NEUTRAL] 1235.
[AGENT][POSITIVE] And I'm ready for the next member when you're ready.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yes. It's, uh, the member's ID is 1449903M as in Mike, L as in Lime5.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] OK. The member's last name is [PII] and the first name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you and again just for the call, all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Yes, the date of services.
[CUSTOMER][NEUTRAL] [PII] and the bill amount is $348.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And would this claim have the same provider or would it be a different provider?
[CUSTOMER][NEUTRAL] It's same like Global pathology Laboratory Service.
[AGENT][NEUTRAL] So I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] Just a moment. [PII]. OK.
[AGENT][NEUTRAL] The claim number is 356-675-9.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the services were
[CUSTOMER][NEUTRAL] February.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] [PII]. Am I correct?
[AGENT][NEUTRAL] That's the day of process, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] A reason?
[AGENT][NEUTRAL] And the claim
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] What is the reason of the night?
[AGENT][NEUTRAL] The claim was denied because the service services were rendered after coverage was terminated.
[AGENT][POSITIVE] The policy was effective. OK.
[CUSTOMER][NEUTRAL] Oh, just one.
[CUSTOMER][NEGATIVE] Services are not.
[CUSTOMER][NEUTRAL] Can you repeat once again?
[AGENT][NEUTRAL] Services were rendered?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] After coverage was terminated. OK.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Services.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And uh, services are rendered after the.
[AGENT][NEUTRAL] Coverage was terminated.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The policy was active from [PII].
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] And there were not
[CUSTOMER][NEUTRAL] February. The policy was active on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me the status of another claim.
[AGENT][NEUTRAL] Can you have the status of another claim? Sure, I'll be more than happy to help you. What's the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's um 944275.
[AGENT][NEUTRAL] 944275 is the policy number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] The members uh last name is [PII] and the member's first name is [PII] sorry, [PII]
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] The date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the um date of service and the total bills?
[CUSTOMER][NEUTRAL] Yes. It's [PII] and the total bill amount is $174.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] Uh thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, so I'm sure to received the claim on [PII].
[CUSTOMER][NEUTRAL] Just a moment. Mm, received on [PII]. OK.
[AGENT][NEUTRAL] The claim number is 356-6502.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And on [PII], the claim was denied because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Services are not covered by this policy, am I correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK just a moment.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Give me the claim status of last claim.
[AGENT][NEUTRAL] Can you have the claim status? Yes, I'll be more than happy to help you, but hold on one moment, let me note this policy.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what's the next member's policy number?
[CUSTOMER][NEUTRAL] OK. It's uh 1433462 M as in Mike, L as in Lime 7.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] OK, and the data er oh, OK, wait, we did him already. All right, and the date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] It's um $101.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, hold on one second.
[AGENT][NEUTRAL] Alright, so I'm showing this claim was received on [PII].
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] The claim number is 356-639-1.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK. May I know the call reference number for the whole call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date. Again, that's [PII]
[AGENT][NEUTRAL] The first initial to my last name is [PII]?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK, thank you. Thank you for your assistance. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're welcome, and thanks for calling APL. Bye-bye.