AccountId: 011433970860
ContactId: aaff8019-90e8-4fcf-88b9-74967990df13
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 971080 ms
Total Talk Time (AGENT): 166946 ms
Total Talk Time (CUSTOMER): 614814 ms
Interruptions: 6
Overall Sentiment: AGENT=0, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/aaff8019-90e8-4fcf-88b9-74967990df13_20250502T14:55_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 the provider to check on the claim status. Please be informed that this call is being recorded and monitored for quality and training purposes. May I know how can I help you with the patient's information or the provider's information?
[AGENT][NEUTRAL] Uh, yes, I can help you with claim status. Can I get a good callback number, [PII]?
[CUSTOMER][NEUTRAL] Uh yeah, it's [PII]. No extension is a direct line.
[AGENT][NEUTRAL] The policy number of the patient?
[CUSTOMER][NEUTRAL] Yeah, the policy number of the patient will be 795153.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's first name will be [PII] and the last name is [PII].
[AGENT][NEUTRAL] And date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Date of birth will be.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] of service will be [PII] and the amount will be $478.12.
[AGENT][NEUTRAL] of service and bill charges.
[CUSTOMER][NEUTRAL] You can.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, that was for [PII] date of service?
[CUSTOMER][NEUTRAL] Uh yeah, [PII].
[AGENT][NEUTRAL] Um, I have a claim for that date, but not for that bill charges. I have bill charges 24 2 13.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Give me a minute. Let me just check, verify one second in the claim form. Give me a minute.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, the total charges are $242.17.
[AGENT][NEUTRAL] OK, we received the claim 3-11-2025 process 312-2025.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Claim was denied because policy terminated [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, give me a minute. Policy term on which date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And what will be the effective date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, [PII]. Could you please tell me when was the last coordination of benefits updated?
[CUSTOMER][NEUTRAL] He diagnosis.
[AGENT][NEUTRAL] Um, we just have the plan effective and term date.
[CUSTOMER][POSITIVE] OK, no worries, and
[CUSTOMER][NEUTRAL] Bear with me just a moment, [PII].
[CUSTOMER][NEUTRAL] That means the uh that means the patient is not active on the date of service. Am I right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Do you see any other pay listed for this patient?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Timely filing for the corrected claim.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEGATIVE] Oh there's no timely filing.
[CUSTOMER][NEUTRAL] What will be the mailing address to submit the corrected claim?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and what will be the mail, uh, what will be the time to find to submit an appeal?
[AGENT][NEUTRAL] 180 days from date of service process.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] From the process date. Am I right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And what will be the mailing address to submit an appeal? OK, yeah, sorry. Is there any specific form for an appeal?
[AGENT][NEUTRAL] Same address.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Could you please help me with the claim number?
[AGENT][NEUTRAL] 357-496-9
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 357-4969. That's it.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Call reference number for our conversation.
[AGENT][NEUTRAL] Uh, my name is [PII], and today's date.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, bear with me.
[CUSTOMER][NEUTRAL] OK, shall we move to the next clean?
[AGENT][NEUTRAL] For a different patient?
[CUSTOMER][NEUTRAL] For the different
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 11 moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK policy number?
[CUSTOMER][NEUTRAL] 1988243 M as in Mike, L as in Lima, and the number 8.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is [PII] and the last name is [PII]. Date of birth will be [PII].
[AGENT][NEUTRAL] OK, um, can you give me that policy number one more time?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, sure. It's 1988243 M as in Mike, L as in Lima, and the number 8.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Alright
[AGENT][NEUTRAL] Data service and bill charges?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Date of service, [PII] and total charges to $50 even.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I don't have a claim on file.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII], you don't have the claim on file. Give me a minute.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, could you please tell me if the patient active on the date of service?
[AGENT][NEUTRAL] Policies effective [PII]. Policy is active, no terminate.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And could you please verify the claim number which I have on file? The claim number is 100001189101259.
[AGENT][NEUTRAL] Um, I, I don't know what that number is. We don't, those aren't our claim numbers.
[CUSTOMER][NEUTRAL] And are you primary or secondary?
[AGENT][NEUTRAL] Secondary.
[CUSTOMER][NEUTRAL] When was the last coordination of benefits updated?
[AGENT][NEUTRAL] We, we just have the policy effective date and.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, no.
[AGENT][NEUTRAL] Secondary.
[CUSTOMER][NEUTRAL] Yeah, OK, you don't have, OK. And claim submission timely filing will be no timely [PII]ng? Am I right? You don't have timely filing?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And mailing address will be the same which you gave me [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And could you please help me with your pay ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] 60801. OK. And what will be the preferred mode of submission will be both paper and mail, sorry, mail and electronic?
[AGENT][NEUTRAL] Uh, either or both.
[CUSTOMER][NEUTRAL] OK. Call reference number will be your name and today's date.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, shall we move to the next claim?
[CUSTOMER][NEUTRAL] I'm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, bear with me, my system got stuck. Just a moment, [PII]. Sorry for that.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Are you ready for the next member ID? OK, the member ID is 778679.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Is your name and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is [PII] and the last name is [PII]. Date of birth will be [PII].
[CUSTOMER][NEUTRAL] Well.
[AGENT][NEUTRAL] This policy is administered by web TPA, I can transfer you over there for claim status.
[CUSTOMER][NEUTRAL] OK. Do you have any contact number for them?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Could you please check with another number?
[AGENT][NEUTRAL] How many more claims do you have?
[CUSTOMER][NEUTRAL] 123. I do have, including this one, I have 5 claims.
[AGENT][NEUTRAL] OK, do you have access to our secured portal?
[CUSTOMER][NEUTRAL] Ah, no, I don't think so.
[AGENT][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] Or you can pull EOB status.
[CUSTOMER][NEUTRAL] No, no, I don't have access to a portal.
[AGENT][NEUTRAL] OK. What's the policy number?
[CUSTOMER][NEUTRAL] The policy number is 1,352,520.
[CUSTOMER][NEUTRAL] Likewise.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] First name of the patient is [PII] and the last name is [PII]. Date of birth will be [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] of service and bill charges.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Date of service [PII] and the charges is.
[CUSTOMER][NEUTRAL] Just a moment. Charges, charges, OK, $270 even to charges.
[AGENT][NEUTRAL] I don't have a claim on file.
[CUSTOMER][NEUTRAL] Bear with me, give me a minute.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] What do you think of that.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Do you have any claim on file for $250 even?
[AGENT][NEUTRAL] I can't search by dollar amount. I can search by date of service.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So for the date of service, you don't have the claim on file for [PII].
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] Bear with me.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK, could you please help me? Is the patient active on the date of service?
[AGENT][NEUTRAL] Yes, effective [PII].
[AGENT][NEUTRAL] Uh, what was the date of service again? I'm sorry. [PII]? No, the policy term.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] If there's a current policy.
[CUSTOMER][NEUTRAL] OK, bear with me.
[CUSTOMER][NEUTRAL] OK. OK. What is the effective date of the member?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, you gave me an old policy number, so I'm pulling up the current one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm thinking about.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] Hey, this, this claim for 12225 was received 3-12-2025. Process 317-2025.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] to be.
[AGENT][NEUTRAL] Office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] OK, and the member's plan?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, I, OK, bear with me just a moment. Uh, when you guys received the claim.
[AGENT][NEUTRAL] 3 12 2025.
[CUSTOMER][NEUTRAL] OK just a moment.
[CUSTOMER][NEUTRAL] Strongii.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And could you please tell me the CPT code is not covered under the member's plan?
[CUSTOMER][NEUTRAL] I I can't really see I don't know.
[AGENT][NEUTRAL] 99213.
[CUSTOMER][NEUTRAL] OK, and the other details will be the same which you gave me before timely find to submit the corrected claim mailing address. Everything will be the same. Could you please provide me the claim number?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] 357-6388.
[CUSTOMER][NEUTRAL] And there is no specific form, am I right?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Is you you will be required by submitting and uh submitting a claim?
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] OK, thanks for your assistance, [PII].
[CUSTOMER][NEUTRAL] And have a great day. I, this was the last time I have on file.
[AGENT][POSITIVE] OK, thank you for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] You too. Bye-bye.