AccountId: 011433970860
ContactId: b07ef22b-23c3-4f7b-8104-d9a2eb305c7e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 823619 ms
Total Talk Time (AGENT): 262969 ms
Total Talk Time (CUSTOMER): 196523 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/b07ef22b-23c3-4f7b-8104-d9a2eb305c7e_20250313T15:35_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 uh my name is [PII]. I'm just looking for the status of some claims.
[AGENT][POSITIVE] Sure, well, I'll be more than happy to help you with the claim statuses and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 01975764 ML 8.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And um, are all the claims for this member, like she has multiple dates of service?
[AGENT][NEUTRAL] Or there are multiple members?
[CUSTOMER][NEUTRAL] Uh, she just has, well, it's multiple members.
[AGENT][NEUTRAL] OK. May I have the date of service for Rain?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] This is for [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Digital medical imaging.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] I'm sure this is it, but it's coming up as a different provider. Can you confirm the the tax ID number?
[CUSTOMER][NEUTRAL] Uh, could it be Center for Diagnostic imaging that tax ID would be [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you for that, and yes, that's what is coming up. Um, so we received it on [PII]. The claim number is 356.
[AGENT][NEUTRAL] 9313.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because benefits are payable only if the major medical provides benefits. If the claim is later paid by uh major medical, just provide the explanation of benefits and we can reprocess.
[CUSTOMER][NEUTRAL] And you said that was denied [PII], correct?
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Perfect. All right, and we can move on to the next number I have.
[AGENT][NEUTRAL] OK, and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Uh, 2 more, sorry, 3 more members to look up.
[AGENT][NEUTRAL] OK, and the next member's policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I have 184-8606.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] That is [PII] for 2,925.
[CUSTOMER][NEUTRAL] For this one, I just need the status of the 721-97.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And would the name of the provider on this claim be the same as well?
[CUSTOMER][NEUTRAL] This one should be digital medical imaging.
[AGENT][NEUTRAL] OK, yes, and I do see that.
[AGENT][NEUTRAL] So for the 721.
[AGENT][NEUTRAL] 721-97 was paid $200.
[CUSTOMER][NEUTRAL] I'm sorry, can you repeat that again?
[AGENT][NEUTRAL] Hm, um, procedure code 72197.
[AGENT][NEUTRAL] $200 was paid towards that code.
[CUSTOMER][NEUTRAL] And have the payment information?
[AGENT][NEUTRAL] Sure, hold on one second.
[AGENT][NEUTRAL] Alright, so it was a single check in the amount of $200.
[AGENT][NEUTRAL] It was issued on [PII].
[AGENT][NEUTRAL] Um, it was mailed to [PII].
[AGENT][NEUTRAL] [PII], but it is coming from [PII], so you probably haven't received it yet.
[CUSTOMER][NEUTRAL] And I'm sorry, you said that was paid through virtual card?
[AGENT][NEUTRAL] No, it was a check in the mail was issued on [PII].
[CUSTOMER][NEUTRAL] Right OK
[CUSTOMER][NEUTRAL] What's the check number?
[AGENT][NEUTRAL] Check number is 2030191.
[CUSTOMER][NEUTRAL] And can I also have the claim number.
[AGENT][NEUTRAL] The claim number is 356.
[AGENT][NEUTRAL] 9390.
[CUSTOMER][POSITIVE] Perfect. Alright, we can move on to the next number.
[AGENT][NEUTRAL] Uh, hold on one moment, let me note this policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] This is 1,423,890.
[AGENT][NEUTRAL] All right, and the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and again just for the call, the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill?
[CUSTOMER][NEUTRAL] This is [PII] for 1250.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] The date of service was [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so there's no claim on file for Wilma for [PII].
[CUSTOMER][NEUTRAL] And would there be any rejections?
[AGENT][NEUTRAL] Well, there there's no claim on file, so we haven't processed anything. Was it filed to their primary?
[CUSTOMER][NEUTRAL] Uh, yes, and then we sent it to you.
[CUSTOMER][NEUTRAL] Three times so far. The most recent one was [PII].
[AGENT][NEUTRAL] And how are you sending it?
[CUSTOMER][NEUTRAL] Uh, this was sent by mail.
[CUSTOMER][NEUTRAL] 2.
[CUSTOMER][NEUTRAL] [PII], I think that's [PII].
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah, that's the old claims mailing address. So if you're sending it to that location, I'm not sure if the mail forwarding is still active, but I can give you our current uh or the claims mailing address if you'd like to resubmit.
[CUSTOMER][NEUTRAL] Uh, yeah, please.
[AGENT][NEUTRAL] Alright, so it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Can I have a reference number as well?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date. And again, my name is [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. Was there anything else? OK, go ahead.
[CUSTOMER][NEUTRAL] Yeah, that's
[CUSTOMER][NEUTRAL] Yeah, I just have one more number to look at.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] All right, and the next member's policy number?
[CUSTOMER][NEUTRAL] This is 1070842.
[AGENT][NEUTRAL] All right, can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] This is [PII].
[CUSTOMER][NEUTRAL] Or [PII]:37.
[CUSTOMER][NEUTRAL] And we sent some medical records and I have the ticket number if you need it.
[CUSTOMER][NEUTRAL] Oh wait, I'm sorry, that is for United Healthcare.
[CUSTOMER][NEGATIVE] My fault.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] So did you, wait, so there is a claim or there isn't because I was gonna tell you I don't see one on file.
[CUSTOMER][NEUTRAL] There there is a claim, but the, the records weren't sent to you guys. We sent it to the, the primary, but I just need the status of the 74176.
[AGENT][NEUTRAL] Primary, OK.
[AGENT][NEGATIVE] Right, but there is no claim on file, so we haven't received it. We haven't received anything.
[CUSTOMER][NEUTRAL] Oh, there is no claim on file, OK.
[AGENT][NEUTRAL] And that was [PII]. I mean, I can double check for you. That was [PII], right?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, there's no claim on file for that data service.
[CUSTOMER][NEUTRAL] And can I also have your guys' payer ID?
[AGENT][NEUTRAL] Sure, it's 60.
[AGENT][NEUTRAL] 80
[AGENT][NEUTRAL] One.
[CUSTOMER][POSITIVE] Perfect. Alright, [PII], well thank you so much for helping me with these claims.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No ma'am, but you have a wonderful day.
[AGENT][POSITIVE] Thank you you also and thanks for calling APO Christian. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.