AccountId: 011433970860
ContactId: b39bc7e0-0e33-4d3d-83c7-5d98669088ee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 477089 ms
Total Talk Time (AGENT): 153050 ms
Total Talk Time (CUSTOMER): 163587 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/b39bc7e0-0e33-4d3d-83c7-5d98669088ee_20250204T16:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling from provider's office for a claim status.
[AGENT][NEUTRAL] I'm sure, [PII] I can assist you with claim status. Um, first, I'll need a callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Yeah, that's gonna be [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] That's gonna be 0161165.
[CUSTOMER][NEUTRAL] ML 7.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient's name is gonna be [PII] and the date of birth is gonna be uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, now I need the date of service and bill charges on the claim, please.
[CUSTOMER][NEUTRAL] That, that service is gonna be [PII]. Charge amount is $455 even.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, please please repeat the bill charges.
[CUSTOMER][NEUTRAL] It's 455 $455 even.
[AGENT][NEUTRAL] For, um, and the date of service is [PII].
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK, I'm not showing a claim on file, not with that date of service and those bill charges.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, um, is the patient active on the data service?
[CUSTOMER][NEUTRAL] Can you please check that?
[AGENT][NEUTRAL] Yes, and just let me advise you that verification of coverage does not guarantee payment of claims. The effective date on this policy was [PII], and the policy is still active, and yes, the patient was active on the date of service.
[CUSTOMER][NEUTRAL] just
[CUSTOMER][NEUTRAL] OK, and are you the secondary for this member on this data service or you're the primary?
[AGENT][NEUTRAL] We're the primary, I'm sorry, we're the secondary insurance.
[CUSTOMER][NEUTRAL] Oh, OK, you're the secondary, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Can you just provide me the um correct mailing address for the, the information?
[AGENT][NEUTRAL] Um, yes, the mailing address for claim submissions is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Could you please repeat the zip code for me?
[AGENT][NEUTRAL] Yes, the zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, and what is the uh timely funding limit for the claims?
[AGENT][NEGATIVE] There's no timely filing limit.
[CUSTOMER][POSITIVE] OK. Thank you so much. And can you also please uh check for me for data service?
[CUSTOMER][NEUTRAL] [PII] for the same patient.
[AGENT][NEUTRAL] Sure, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, I'm not showing any claims on file for [PII].
[CUSTOMER][NEUTRAL] OK, you don't see any payment file for that as well.
[CUSTOMER][NEUTRAL] OK. Uh, can you just check, OK. I have the last, one last, uh, name. Could you just check? It's gonna be for a different number.
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK. One moment, [PII].
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] OK, thanks for your patience. I'm ready for the next policy number.
[CUSTOMER][NEUTRAL] The next policy number is gonna be, yeah.
[CUSTOMER][NEUTRAL] Uh 06, 0 no, let me just repeat. It's 01611652 ML 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient's name is gonna be [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And date of service and bill charges on the claim, please.
[CUSTOMER][NEUTRAL] The service is gonna be for [PII]. Charge amount is $530 even.
[AGENT][NEUTRAL] No, sir. I'm not showing that claim on file either.
[CUSTOMER][NEUTRAL] OK. Can you just verify to me the number active date?
[AGENT][NEUTRAL] Um, yes, and just let me advise you that verification of coverage does not guarantee payment of claims. The effective date on this policy was [PII], and the policy is still active.
[CUSTOMER][NEUTRAL] The effect
[CUSTOMER][NEUTRAL] OK. And um do you cover the primary uh deductible and the co-insurance?
[AGENT][NEUTRAL] Um, for what type of service? Is it for an office visit or outpatient services?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Alright, let me just check this one. Just give me a moment.
[CUSTOMER][NEUTRAL] OK, let me just go here.
[CUSTOMER][NEUTRAL] It's an office visit.
[AGENT][NEUTRAL] OK, the co-pay for the office visit?
[CUSTOMER][NEUTRAL] Co-pay for the office
[AGENT][NEUTRAL] Let's see, that's not covered, but for services provided in the office, we do cover that. That's covered up to, let's see.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Pro
[AGENT][NEUTRAL] That's covered up to 1500 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, OK, great. Thank you so much, really appreciate it. Um, I'm so sorry, but I couldn't get your name, so could you please help me with your name again?
[AGENT][NEUTRAL] Yes, my name is [PII]. Um, it's spelled [PII] and my last initial is [PII]. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] Uh, no, great, thank you so much. This is all for today. I would like to have the call reference number for our conversation lastly.
[AGENT][NEUTRAL] The call reference number is my name and today's date.
[CUSTOMER][NEUTRAL] So call
[CUSTOMER][POSITIVE] OK, great. Thank you so much, we really appreciate it. You have a wonderful day ahead.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL. Mm bye.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.