AccountId: 011433970860
ContactId: abc3c228-9a4a-4c03-9136-b54cb6a254a1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 354119 ms
Total Talk Time (AGENT): 104947 ms
Total Talk Time (CUSTOMER): 192018 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/abc3c228-9a4a-4c03-9136-b54cb6a254a1_20250312T16:09_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], and I'm calling you for the provider to check on a claim status and please be informed that this call has been recorded and monitored for quality and training purposes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status, and [PII], how many claims do you have in total today?
[CUSTOMER][NEUTRAL] There is only one claim.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] it's a direct line.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it is 00490984.
[CUSTOMER][NEUTRAL] So yeah.
[AGENT][NEUTRAL] 004908984.
[CUSTOMER][NEUTRAL] 0094 0984.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry, can you just repeat the policy number over for me?
[CUSTOMER][POSITIVE] Exactly
[CUSTOMER][NEUTRAL] Yeah, yeah, sure, sure. 00940984.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Member first name is.
[CUSTOMER][NEUTRAL] [PII]. Last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] It is 11-25-2024 and the total bill amount is, allow me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] It is $1,083 even.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] For [PII] for [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm not showing a claim on file for that data service.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. Uh, could you please help me with the policy effective and terminate for the member?
[AGENT][NEUTRAL] So the policy is still active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] OK. And when, uh, is it a term right now?
[AGENT][NEUTRAL] No, the policy is still active.
[CUSTOMER][NEUTRAL] OK. And you guys are secondary for this member, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, allow me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sorry.
[CUSTOMER][NEUTRAL] And also could you please let me know from uh uh when was the last coordination of benefit was updated for this member?
[CUSTOMER][NEUTRAL] Do you have information regarding that?
[AGENT][NEUTRAL] Um, just
[AGENT][NEUTRAL] There's no coordination of benefits. This policy is second only to United Health, um, United NHP.
[CUSTOMER][NEUTRAL] OK, and could you please let me know the mailing address to submit the claim? Is it, allow me a second.
[AGENT][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] I'd like to verify the address. Is it [PII]?
[AGENT][NEGATIVE] No, that's not correct.
[CUSTOMER][NEUTRAL] Could you please help me with the address?
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And also could you please let me know what will the payer ID.
[AGENT][NEUTRAL] Our pay ID is 60801.
[CUSTOMER][NEUTRAL] OK, and we can submit in both format, right? electronically as well as in a paper?
[AGENT][NEUTRAL] Yes, and you can fax it as well if you like.
[CUSTOMER][NEUTRAL] Uh, what will be the fax number?
[AGENT][NEUTRAL] It's 877.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK, and what will be the timely filing to submit the claim?
[AGENT][NEUTRAL] So there's no timely filing as long as the policy was active on the data service, you can file the claim at any time.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Allow me a moment.
[CUSTOMER][NEUTRAL] OK, and also could you please let me know what will be the reference number for today's call.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, and again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you for your assistance and have a great day. Take care. Bye-bye.
[AGENT][POSITIVE] You're very welcome, [PII]. You also, and thanks for calling APO. Bye-bye.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.