AccountId: 011433970860
ContactId: c3851257-94a8-408c-a0db-1d2da3e2dcb0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 453170 ms
Total Talk Time (AGENT): 196750 ms
Total Talk Time (CUSTOMER): 101412 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/c3851257-94a8-408c-a0db-1d2da3e2dcb0_20250528T14:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] And yes, I just need to check claim status please.
[AGENT][NEUTRAL] OK, can I get a name and a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII] in [PII] that's my direct line.
[AGENT][NEUTRAL] OK, [PII], and do you have a policy number?
[CUSTOMER][NEUTRAL] Yes, that is.
[CUSTOMER][NEUTRAL] 02544610
[AGENT][NEUTRAL] OK, let me check on that and I can help you with claim status.
[AGENT][NEUTRAL] Can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] And do you have the um claim number or date of service?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 113 2025 and that's for $833.
[CUSTOMER][POSITIVE] So it looks like I called um and spoke with Easy on.
[CUSTOMER][NEUTRAL] 324 and she stated no claim on file so I dropped both the UB and the 1500 and faxed them.
[AGENT][NEUTRAL] OK, let me check.
[AGENT][NEUTRAL] Could you
[AGENT][NEUTRAL] Right, $133.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK, let me double check and what's the provider's name?
[CUSTOMER][NEUTRAL] Uh, Curtin Community Hospital.
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] It looks like we received this claim on [PII].
[AGENT][NEUTRAL] The claim was processed on [PII].
[AGENT][NEUTRAL] It looks like that claim was denied and let me see why.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like, so is this for a medical appointment?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, he, he gave you his dental policy, so that's why the claim was denied.
[CUSTOMER][NEUTRAL] Oh, does he have medical coverage?
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] OK, and the date of service was the [PII]? OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, it looks like he has hospital indemnity and group or he had hospital indemnity and group accident during that time of service. Um, do you know what it was in regards to?
[CUSTOMER][NEUTRAL] Um, it just is an emergency room visit and.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] So you'll probably want to file that under his hospital indemnity policy and I can give you that policy number.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um, whenever you're ready and we, we have to refile the claim under that that policy number. OK, let me pull it up.
[CUSTOMER][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The policy is 25.
[AGENT][NEUTRAL] 44
[AGENT][NEUTRAL] 608.
[CUSTOMER][NEUTRAL] OK, 254-460-8.
[AGENT][NEUTRAL] Yes ma'am, and that's his hospital indemnity policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and what was your name?
[AGENT][NEUTRAL] My name is [PII]. Last initial [PII].
[CUSTOMER][NEUTRAL] OK, and is that gonna be your reference number first name?
[AGENT][NEUTRAL] Uh, first name, last initial, and today's date.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Do you have our fax number?
[CUSTOMER][NEUTRAL] And um.
[CUSTOMER][NEUTRAL] Yes, let me just verify that if I can. I think um this I have.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I fax the claims lastly to [PII].
[CUSTOMER][NEUTRAL] Is that where they should go?
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] You said 942-3, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so since we're doing it through a hospital indemnity policy, let me check and see.
[AGENT][NEUTRAL] You don't wanna do it, uh, you don't wanna submit the claim.
[AGENT][NEUTRAL] To IMA and let me find our fax number.
[CUSTOMER][NEUTRAL] And IMA is International Medical.
[AGENT][NEUTRAL] Because that's where you would send the.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah, dental policies or dental um claims for this policy will go to that fax number.
[AGENT][NEUTRAL] I'm not showing a fax fax number for IMA which is going to be that hospital indemnity claim. Um, you'll want to send it through the mail and I can give you that mailing address and the payer ID as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it will be IMA.
[AGENT][NEUTRAL] And [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] In [PII], so [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And their payer ID is 64556.
[CUSTOMER][NEUTRAL] 645-556 OK and what does IMA stand for?
[AGENT][NEUTRAL] I don't know what it stands for, but for, for those claims, even though he had had the policy through us, it goes through IMA so it's probably a 90 degrees a 90 degree or a multi-plan policy, which has to go through them first.
[CUSTOMER][NEUTRAL] OK, and do you know what our timeline is?
[AGENT][NEUTRAL] Um, we don't have timely filing limits, so that one won't either.
[CUSTOMER][NEGATIVE] Oh, you guys don't have timely at all.
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] OK, that's really nice that's really good to know OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I will get these either submitted electronically or through the mail.
[AGENT][POSITIVE] Great thank you so much for calling [PII]. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.