AccountId: 011433970860
ContactId: a7e91a9f-65ed-4c6d-ab87-8578957583cd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 421200 ms
Total Talk Time (AGENT): 149236 ms
Total Talk Time (CUSTOMER): 153824 ms
Interruptions: 0
Overall Sentiment: AGENT=2.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/a7e91a9f-65ed-4c6d-ab87-8578957583cd_20250220T14:06_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] Hello, um, [PII]. My name is [PII]. I'm calling for Munson Medical Center to check on a claim status.
[AGENT][POSITIVE] Oh, it would be my pleasure to assist you with claim status. Do you mind?
[AGENT][NEUTRAL] Spelling your name for documentation please.
[CUSTOMER][NEUTRAL] Of course. Um, my name spells [PII].
[AGENT][POSITIVE] Thank you, [PII]. And what is a good callback number, please?
[CUSTOMER][NEUTRAL] Yes, my call back number is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry, I just
[AGENT][POSITIVE] Take your time.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] My callback number
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And [PII], what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Patient's policy number is?
[CUSTOMER][NEUTRAL] 682-658-481.
[AGENT][NEUTRAL] That is not the APL policy number.
[AGENT][NEUTRAL] Is that maybe a social?
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Yes, um, member's social security number is.
[AGENT][NEUTRAL] Bear with me just one second, let me get to that screen.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] Thank you. And what is the patient's name?
[CUSTOMER][NEUTRAL] Yes. Patient's name is [PII].
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is [PII]'s date of birth, please?
[CUSTOMER][NEUTRAL] Yes, uh, [PII]'s date of birth is [PII].
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. I do have her policy pulled up. Would you like that policy number for APL?
[CUSTOMER][NEUTRAL] Yes, uh, of course. May I please know this patient's correct policy number?
[AGENT][NEUTRAL] Yes, for APL her policy number is 250.
[AGENT][NEUTRAL] 4451.
[CUSTOMER][POSITIVE] Thank you. 2504451.
[AGENT][NEUTRAL] Yes, sir. And this policy was active.
[AGENT][NEUTRAL] Alright, it is active and the effective date is [PII].
[AGENT][NEUTRAL] And I understand you're needing claim status, but [PII], we have no claims on file for the [PII].
[CUSTOMER][NEUTRAL] OK. But could you please confirm if your insurance company covers this patient's medical expenses as primary or secondary?
[AGENT][NEUTRAL] Well this is a limited indemnity policy.
[AGENT][NEUTRAL] It's not major medical.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it, she does have benefits for medical expenses.
[CUSTOMER][NEUTRAL] So you don't coordinate with any other insurance companies to
[CUSTOMER][NEUTRAL] Share the benefits, right? So this is the only coverage that this change.
[AGENT][POSITIVE] That's correct.
[AGENT][POSITIVE] Yes, sir that is correct.
[CUSTOMER][MIXED] OK, but it, it's an empty plan which doesn't.
[CUSTOMER][NEUTRAL] Um, you know, the patients.
[CUSTOMER][NEUTRAL] It's just a limited policy, right? That that there will be no.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] All right, thank you so much, um, [PII] for you, I mean, so now.
[AGENT][POSITIVE] That's right, I, I do that too sometimes.
[CUSTOMER][NEUTRAL] Leisure.
[AGENT][POSITIVE] Well, it's been a pleasure to help you with that eligibility. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Yes, uh, I, I would like to resubmit this claim, um, again, since you confirm that you did not receive this claim. So I'd like to, I mean, you have no claims for this patient, right, on the, on your system?
[AGENT][POSITIVE] It's good.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That is correct. And I can provide the claim submission information. You can mail it or fax it to our claims department.
[CUSTOMER][NEUTRAL] OK. Uh,
[AGENT][NEUTRAL] Which would you like both our address and fax number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, um, a client's mailing address is enough at this time. In case if I, if you don't receive the claim even though we, uh, submitted more than twice to the mailing address, then only, um, I would need your fax number to fax the claim. We always prefer mailing address.
[AGENT][NEUTRAL] OK, no, I can
[AGENT][NEUTRAL] All right, I can provide that address for you. It is APL Claims.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] City, [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] May I know if any specific time limit to get the claim submitted?
[AGENT][NEGATIVE] There's no timely filing.
[CUSTOMER][POSITIVE] OK, thank you so much, um, [PII] for your kind assistance. May I please know if you have any reference number for this call?
[AGENT][NEUTRAL] It would be my name in today's date, and I spell my name [PII]
[AGENT][NEUTRAL] First initial and my last name is [PII].
[CUSTOMER][NEUTRAL] We are required to submit this claim directly to um APL insurance company is isn't it not to that, not to any pricing company like managed care.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Um, encompass health, OK.
[AGENT][POSITIVE] That's correct. Directly to us.
[CUSTOMER][NEUTRAL] All right then.
[CUSTOMER][POSITIVE] OK, thank you so much. Have a nice day. Bye bye.
[AGENT][POSITIVE] My, my pleasure to assist you today. Thank you for calling APL and I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] Yes, you do the same bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.