AccountId: 011433970860
ContactId: b397cd22-eee5-4225-b406-ffeea6e8d753
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 462649 ms
Total Talk Time (AGENT): 157233 ms
Total Talk Time (CUSTOMER): 220501 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/b397cd22-eee5-4225-b406-ffeea6e8d753_20250306T22:09_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hi, I'm [PII], and I'm calling for the provider. It's [PII] Orthopedic and Sports Medicine Specialist. Please be informed that this call will be recorded and monitored for quality and training purposes. I'm calling to check on a claim status.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] It would be my pleasure to assist you with that claim status, [PII]. What is a good callback number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you. And [PII], what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, the policy number is
[CUSTOMER][NEUTRAL] D as in Delta 43731565.
[AGENT][NEUTRAL] That is not our APL policy number.
[AGENT][NEUTRAL] Our policy number is all numerical.
[CUSTOMER][NEUTRAL] Just a moment, let me see whether I have right now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Actually, I have that as a uh member ID. Just a moment.
[AGENT][NEUTRAL] Do you have, or if you have a claim number, I can look it up by claim number.
[CUSTOMER][NEUTRAL] Yeah, sure. Just a moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Actually, I don't have claim number 2.
[AGENT][NEUTRAL] OK, let's do a name search.
[CUSTOMER][NEUTRAL] Wait a moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Let me see if I have any other.
[CUSTOMER][NEUTRAL] Member ID.
[CUSTOMER][NEUTRAL] Where
[CUSTOMER][NEUTRAL] Actually, we have the 43731565. That is the member ID we have.
[AGENT][NEUTRAL] OK, I can look by name. What's the last name of the patient?
[CUSTOMER][NEUTRAL] So can you
[CUSTOMER][NEUTRAL] Yeah, sure. The last name of the patient is [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] First name is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And is that first letter T as in Tango or C as in Charlie?
[CUSTOMER][NEUTRAL] [PII] as in Tango. Tango [PII] Alpha [PII] cream.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the first name, please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] Do you happen to have the social? I'm unable to locate him by name.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Just uh yeah, I have social security number. Just a moment.
[AGENT][NEUTRAL] Let's try that.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] See if I can locate him with the social.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is this for medical coverage?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I did find him by social.
[CUSTOMER][NEUTRAL] A gentle.
[AGENT][NEUTRAL] For medical, are you, and you need, you are needing medical claim status?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I need the general claim status.
[AGENT][NEUTRAL] OK, let me get that dental policy pulled up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Can you verify Mr. [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, sure. The date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, thank you. Oh, we have his last name listed as [PII] and first name listed as [PII].
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's why I couldn't find him by name.
[CUSTOMER][NEUTRAL] OK, so you can able to
[AGENT][NEUTRAL] But he does.
[AGENT][NEUTRAL] I did find his dental policy is in social.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I can give you that dental policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The policy number for his dental coverage is 025.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 20936.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] So this is the policy number, right?
[AGENT][POSITIVE] That's correct for his dental coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] And I was checking, we do not have a claim on file. You can actually fax that claim directly to our claims department.
[CUSTOMER][NEUTRAL] Mhm. So for the date of service of
[CUSTOMER][NEUTRAL] [PII] and total charges of $119 you don't have claim on file.
[AGENT][NEUTRAL] That is correct, and the policy was active for that date of service. The effective date on his policy is [PII] and active.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thank you. Uh, and your primary for the patient, right?
[AGENT][NEUTRAL] For dental, mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you so much. May I know the claim's mailing address?
[AGENT][NEUTRAL] Claims mailing address is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][POSITIVE] Thank you so much. May I know the electronic payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][POSITIVE] Thank you so much. May I know the timely filing limit to resubmit the claim?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] There's no timely filing.
[CUSTOMER][POSITIVE] Thank you so much. May I know the mode of submission whether we can submit electronic or paper claim or mail?
[AGENT][NEUTRAL] Either way
[CUSTOMER][POSITIVE] Thank you so much. May I know the call reference number?
[AGENT][NEUTRAL] Call reference number is my name and today's date. I spell my name [PII]
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I think.
[CUSTOMER][NEUTRAL] Hey.
[AGENT][NEUTRAL] First initial and my last name is [PII].
[CUSTOMER][POSITIVE] OK. Thank you, A[PII]. Thank you for your assistance. Have a wonderful day. Take care. Bye-bye.
[AGENT][POSITIVE] It's been my pleasure to assist you, [PII]. Thank you for calling APL and I hope you have a wonderful day as well.
[CUSTOMER][NEUTRAL] Yeah, bye-bye.
[AGENT][NEUTRAL] Bye bye.