AccountId: 011433970860
ContactId: bdb9350f-7012-4e38-ba9c-0b3614f5c5da
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 575549 ms
Total Talk Time (AGENT): 171671 ms
Total Talk Time (CUSTOMER): 200126 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/bdb9350f-7012-4e38-ba9c-0b3614f5c5da_20250207T19:59_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. This is [PII] calling from provider office checking for the claim status. Your name?
[AGENT][NEUTRAL] OK, I can verify the claim status, [PII]. It's [PII] last initial [PII]
[AGENT][NEUTRAL] And what is that policy number, please? Oh, you're welcome.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Yeah. It's 02473008.
[CUSTOMER][NEUTRAL] 2 M as in Mike. L as in Lima, 8 as in sorry, 8.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] What was the last four digits? I'm sorry.
[CUSTOMER][NEUTRAL] Direct line?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Sorry, [PII].
[AGENT][NEUTRAL] OK, thank you. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Yeah, patient's name is, it's [PII] uh it's
[CUSTOMER][NEUTRAL] And our date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And you said you're calling for claim status, correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Uh, what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] 10,014
[CUSTOMER][NEUTRAL] Sorry, [PII], 2024. And the bill amount is $39,652 even.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Hey, I don't show you received any claims. Uh, can you verify the mailing address the claim was submitted to?
[CUSTOMER][NEUTRAL] mailing address for this one is, it's [PII].
[AGENT][NEUTRAL] Uh, that is correct. Um, so you can resubmit the claim by mail or you can fax it. I'm sorry?
[CUSTOMER][NEUTRAL] The claim was billed by the local.
[CUSTOMER][NEUTRAL] Yeah. Can you please provide me the uh patient is active on the state of service?
[AGENT][NEUTRAL] Yes, showing an effective date of, give me one moment.
[AGENT][NEUTRAL] Uh, uh, looks like the effective date [PII] and the policy is active.
[CUSTOMER][NEUTRAL] No it's still active.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What is the uh same mailing address?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] Uh, just a second, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] uh-huh.
[CUSTOMER][NEUTRAL] Family falling?
[AGENT][NEGATIVE] Uh, there's no timely filing.
[CUSTOMER][NEUTRAL] OK. And uh what is the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. And is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Uh yeah. Uh, just a second. I'm checking for the, uh for another one or not.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'll just, I just need the call reference number for this one.
[AGENT][NEUTRAL] Uh, we don't give reference numbers. If you like, you may use my name and Sta State.
[CUSTOMER][NEUTRAL] Your name and address. OK. Thank you so much, OK. Uh, well, I have just one more claim. Can you please help me with that one?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. So for the same patient or different patient?
[CUSTOMER][NEUTRAL] This is for the different one, I think, just a second, I'm checking.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it's different.
[AGENT][NEUTRAL] OK, and what's that policy number, please?
[CUSTOMER][NEUTRAL] Policy number is 02458509.
[AGENT][NEUTRAL] OK, see, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Patient's name for this one is, it's uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] Date of service for this one is, just a second.
[CUSTOMER][NEUTRAL] It's [PII] and the uh bill amount for this one is $875 even.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] [PII], data service, correct?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] And the name of the provider's office?
[CUSTOMER][NEUTRAL] Montemi Regional Hospital.
[AGENT][NEUTRAL] OK, I'm showing that claim process is needing the primary EOB.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So you can resubmit that EOB, you can mail it or fax it to our office.
[CUSTOMER][NEUTRAL] Yeah, who is the primary for this one?
[AGENT][NEUTRAL] Uh, you have to contact the patient. Uh, the policy they have with us is a secondary policy online.
[CUSTOMER][NEUTRAL] Please provide me the received date process date.
[AGENT][NEUTRAL] Uh, the claim was received [PII], processed on [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, processed on [PII].
[CUSTOMER][NEUTRAL] Thank you. What is the claim number?
[AGENT][NEUTRAL] Uh, the claim number is 354-6116.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Claim is denied due to it.
[CUSTOMER][NEUTRAL] Primary EOB, uh, just checking the primary EOB I have in the system.
[CUSTOMER][NEUTRAL] It is correct or not. Let's check that one.
[AGENT][NEUTRAL] Well, we haven't received it. So if you have the primary it will be, you can submit it to our office.
[CUSTOMER][NEUTRAL] OK. Uh, can you please, uh, this mailing address we need to send?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And what is the time calling?
[AGENT][NEUTRAL] Uh, there's no time limit.
[CUSTOMER][NEUTRAL] OK. Uh, just confirm that. Uh, I just need the [PII] after that [PII]. Is it correct?
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So we have the uh primary, it means primary insurance uh is, it's United Healthcare.
[CUSTOMER][NEUTRAL] United Healthcare Choice Plus.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the member ID is 4,141,786,250, is it correct? You have that information?
[AGENT][NEUTRAL] I have no, we wouldn't have their primary policy number or information. We just need the primary EOB. So if you have that EOB, if you can mail that to us or fax it, then we can go back and reprocess the claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Thank you. Uh, just a second.
[CUSTOMER][NEUTRAL] And uh can you please provide me the call reference number for this one?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. If you like, you may use my name at today's date.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][POSITIVE] Yes, I have that one. Well, uh, OK, I'm done with this. Thanks for assisting me. Have a wonderful day.
[AGENT][POSITIVE] You're welcome. You too, and thank you for calling APL. Bye.
[CUSTOMER][NEUTRAL] Yeah bye.