AccountId: 011433970860
ContactId: ae542408-b044-4772-864f-99814e2f02de
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 532570 ms
Total Talk Time (AGENT): 169508 ms
Total Talk Time (CUSTOMER): 126226 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/ae542408-b044-4772-864f-99814e2f02de_20250224T19:04_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office.
[AGENT][NEUTRAL] Hi, [PII], how are you doing today?
[CUSTOMER][POSITIVE] I'm good how are you doing?
[AGENT][POSITIVE] I'm doing well, and how may I assist you today?
[CUSTOMER][NEUTRAL] Yeah, actually, I call regarding to to check the claim status.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Uh, just a one.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] with the extension of [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, just a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it's
[CUSTOMER][NEUTRAL] C
[CUSTOMER][NEUTRAL] 05894098
[AGENT][NEUTRAL] OK, do you have a copy of the APL policy?
[AGENT][NEUTRAL] ID card?
[CUSTOMER][NEUTRAL] Just a second, I'll pull it out.
[CUSTOMER][NEUTRAL] Yeah, I do have ID card.
[AGENT][NEUTRAL] OK, on the ID card, do you see anywhere that says in hospital or outpatient policy certification number?
[CUSTOMER][NEUTRAL] You know,
[AGENT][NEUTRAL] OK, to the top left corner of the card, do you see APL?
[CUSTOMER][NEUTRAL] I don't see any of the people.
[AGENT][NEUTRAL] OK, what, um, do you have the member's policy number? I can try to look it up with the policy number or the member's first and last name?
[CUSTOMER][NEUTRAL] Yeah, the first name and the last name is?
[CUSTOMER][NEUTRAL] It's [PII] and [PII]
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And the spelling of the first name was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one second. I'm just waiting for the policies to come up.
[AGENT][NEUTRAL] And can you verify the member's um date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So that policy number is 166.
[AGENT][NEUTRAL] 1549.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] The date of service is uh [PII].
[CUSTOMER][NEUTRAL] And the total amount is $11,315.80.
[AGENT][NEUTRAL] OK, [PII] $11,315.80.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. I believe I just located the claim. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] In the.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I think
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It's, it's Surgery center at [PII].
[AGENT][NEUTRAL] OK, the reason I'm asking is because we have 2 claims on file for that data service, but neither of them is with the total, your total bills or the provider.
[AGENT][NEUTRAL] Let me double check the first one I checked just in case.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 993.
[AGENT][NEUTRAL] Yeah, this is a different provider too, yeah. So there's no claim on file for your data service or total bills.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] You have, you just said that there is no claim on file.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Can I have the payer ID so we can resubmit the claim, the payer ID, and how do you accept it is an electronic or in the paperware?
[CUSTOMER][NEUTRAL] And all the details like the mailing address.
[AGENT][NEUTRAL] Wait, I'm sorry, can you repeat that slowly, please? I, I didn't. Can you repeat that slowly, please?
[CUSTOMER][NEUTRAL] Yeah, you just said, said that there is no claim on file, so we'll, we would like to resubmit the claim.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So for the resubmit the claim, how do you accept the claim through your submission like it's in a paper paper way or in an electronic way?
[AGENT][NEUTRAL] Oh, it's up to your preference. You can fax it, you can mail it, or you can send it electronically.
[CUSTOMER][NEUTRAL] I have the payer ID and uh the mailing address and the fax number.
[AGENT][NEUTRAL] Sure, so our pay ID is 60801.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Our fax number is 877.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Just a second, I'll just make it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please repeat that?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Can you please repeat the fax number?
[AGENT][NEUTRAL] 877
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[AGENT][NEUTRAL] And that's attention, APL claims department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] The mailing address would be?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So what is the timely filing limit?
[AGENT][NEUTRAL] Um, there's no timely filing limit as long as the policy was active on the data service and
[AGENT][NEUTRAL] This policy, let me see. Yeah, this policy has been active since [PII] for this number.
[CUSTOMER][POSITIVE] All right, [PII], I'll just resubmit the claim with the provider details and thank you so much for your time. And in the meanwhile, can I have the call reference number please?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Thank you and I thank you so much for your time and have a good day.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Good, thank you. No.
[AGENT][POSITIVE] All right. Well, thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Bye bye.