AccountId: 011433970860
ContactId: c4d0e30a-eadd-406e-845e-838f7ec65031
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 880359 ms
Total Talk Time (AGENT): 216024 ms
Total Talk Time (CUSTOMER): 478410 ms
Interruptions: 23
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/c4d0e30a-eadd-406e-845e-838f7ec65031_20250228T17:03_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] Hello, ma'am. My name is [PII]. My last name is there. I am calling to you from provider office C with specialties. I need the general claim status.
[AGENT][NEUTRAL] It would
[AGENT][POSITIVE] It would be my pleasure to help you with claim status and do you mind spell your name for documentation?
[CUSTOMER][NEUTRAL] You see my question.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] you the number?
[AGENT][NEUTRAL] Can you spell your name for documentation purposes?
[CUSTOMER][NEUTRAL] OK. My name is [PII] initial of last name is [PII].
[AGENT][NEUTRAL] Thank you, [PII], and what is a good callback number?
[CUSTOMER][NEUTRAL] [PII] and extension is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the patient's policy number?
[CUSTOMER][NEUTRAL] OK, I checked.
[CUSTOMER][NEUTRAL] The policy number is
[CUSTOMER][NEUTRAL] D is David 40306502.
[AGENT][NEUTRAL] Thank you. Now that is not the APL policy number.
[CUSTOMER][NEUTRAL] that the ACL policy number.
[AGENT][NEUTRAL] Do you have the APL policy certificate number?
[CUSTOMER][NEUTRAL] You have the AP policy.
[CUSTOMER][NEUTRAL] Uh I think.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, the policy number is
[CUSTOMER][NEUTRAL] 02556561
[AGENT][NEUTRAL] 02556511.
[CUSTOMER][NEUTRAL] 3255651161.
[AGENT][NEUTRAL] 2556561.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, thank you. And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The patient's last name is [PII] and first name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] Thank you, and I understand you're needing eligibility for Kingston?
[CUSTOMER][NEUTRAL] and it's.
[CUSTOMER][NEUTRAL] I need the claim detailed claim status please, general claim status.
[AGENT][NEUTRAL] OK, I can help you with that claim status. Now Moises, um, the policy was active on [PII].
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] And, um, active on [PII].
[AGENT][NEUTRAL] The, we have no claims on file for [PII].
[CUSTOMER][NEUTRAL] We, we have no claims on file.
[CUSTOMER][NEUTRAL] Can you again please uh the policy is the term.
[AGENT][NEUTRAL] The policy is active, yes, sir.
[CUSTOMER][POSITIVE] Healthy.
[CUSTOMER][NEUTRAL] OK, uh, the policy active date, start date, and term date please.
[AGENT][NEUTRAL] No term date on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Star please.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I'm sorry. The policy started again.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] OK ma'am, but, uh, last time I had um.
[CUSTOMER][NEUTRAL] Claim sent through paper.
[CUSTOMER][NEUTRAL] Paper claim, but
[CUSTOMER][NEUTRAL] You said it's not
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] No claims on file.
[CUSTOMER][NEUTRAL] You change some time.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Do you want to verify the claim's address?
[CUSTOMER][NEUTRAL] Uh, I have, yes, I have sent the claim mailing address last time [PII] and then [PII].
[AGENT][NEUTRAL] I apo
[AGENT][NEUTRAL] OK, I can give you the correct address. That's not the correct address.
[CUSTOMER][NEUTRAL] I can give you the correct address. That's not the correct.
[CUSTOMER][NEUTRAL] OK, please uh uh yes.
[CUSTOMER][NEUTRAL] Correct address, please?
[AGENT][NEUTRAL] Yes, the correct address is [PII].
[CUSTOMER][NEUTRAL] It's the correct address is [PII].
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And the city is [PII], that's [PII]
[CUSTOMER][NEUTRAL] And the city is, that[PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Spell please.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] You need to for me to spell the state?
[CUSTOMER][NEUTRAL] You need to for me to spell the state? OK.
[AGENT][NEUTRAL] The state name is [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] [PII] and next [PII].
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] [PII]. I don't have the additional zip code.
[CUSTOMER][NEUTRAL] [PII] OK.
[CUSTOMER][NEUTRAL] OK, and I have the payer ID, please.
[AGENT][NEUTRAL] Payer ID is 64556.
[CUSTOMER][NEUTRAL] The ID is 6455.
[CUSTOMER][NEUTRAL] OK, the pay ID is not for work for this time because last time I had, uh, um, send through electronically but did not receive your insurance.
[AGENT][NEUTRAL] So it goes to payer ID 64556.
[CUSTOMER][NEUTRAL] So it goes to payer ID 4556. Yes.
[AGENT][NEUTRAL] But we don't have the claim on file.
[CUSTOMER][NEUTRAL] Well we don't have.
[CUSTOMER][NEUTRAL] OK, I have the new claim timely filing.
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] New plane time traveling, no.
[AGENT][POSITIVE] That's correct. No timely filing.
[CUSTOMER][NEUTRAL] OK, and corrected claim family filing.
[AGENT][NEGATIVE] No timely filing for corrected claim.
[CUSTOMER][NEUTRAL] OK, OK, any time, any time I have send the, uh, claim, is that right?
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. You said the correct mailing address is [PII].
[CUSTOMER][NEUTRAL] [PII], is that right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that
[CUSTOMER][NEUTRAL] Patient is effective. Uh our date of service is [PII]. Is that right?
[AGENT][NEUTRAL] That's correct, yes, the policy was active for that data service.
[CUSTOMER][NEUTRAL] Oh, OK, you said the policy starts [PII], uh, sorry, uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That that's, it's [PII].
[CUSTOMER][NEUTRAL] Oh, OK, OK, the start date. OK, no problem, OK.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK, I see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I check.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I have the insured's name please again.
[AGENT][NEUTRAL] My name is [PII] I. I'm sorry.
[CUSTOMER][NEUTRAL] No, no, no, uh, I, I said, I said insurance name, their name.
[AGENT][NEUTRAL] APL, I apologize.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, APL I am insurance, is that right?
[AGENT][NEUTRAL] So, the medical coverage is through APL.
[CUSTOMER][NEUTRAL] So the medical coverage is through ACL.
[AGENT][NEUTRAL] The claims do go to IMA.
[CUSTOMER][NEUTRAL] The claim C I M A.
[AGENT][NEUTRAL] But for medical coverage, the company insurance name is APL.
[CUSTOMER][NEUTRAL] our medical company.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Because the last time I have sent the paper claim I am insurance.
[AGENT][NEUTRAL] It goes to IMA for repricing.
[CUSTOMER][NEUTRAL] It goes to IMA for repricing.
[AGENT][NEUTRAL] And then they forward medical claims to APL.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, APL insurance.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, please you check the uh member payer ID is uh correct.
[AGENT][NEUTRAL] The payer ID is 64556.
[CUSTOMER][NEUTRAL] No, no, no, no, uh, sorry, I mis I mistaken.
[CUSTOMER][NEUTRAL] Uh, the member ID I said member ID.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, the policy number with APL is 2556561.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Sure, policy number with AVO is 255.
[CUSTOMER][NEUTRAL] OK, and group number?
[AGENT][NEUTRAL] The group number is.
[AGENT][NEUTRAL] 70019.
[CUSTOMER][NEUTRAL] 70019.
[CUSTOMER][NEUTRAL] OK, 70019.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so now I have sent uh the uh through electronically.
[CUSTOMER][NEUTRAL] Oh paper you.
[CUSTOMER][NEUTRAL] As me, uh, just, um.
[AGENT][NEUTRAL] You either one is fine.
[CUSTOMER][NEUTRAL] Can you repeat your question, please?
[AGENT][NEUTRAL] I'm sorry, can you repeat that?
[CUSTOMER][NEUTRAL] OK, uh, I said that I have sent the claim through elect electronically.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And by fax please you.
[CUSTOMER][NEUTRAL] Check
[AGENT][NEUTRAL] And what number did you fax it to?
[CUSTOMER][NEUTRAL] The number is.
[CUSTOMER][NEUTRAL] No, I, I have sent, I said I have the claim through electronically or, or by mail. Please confirm, is that correct? This is for by mail.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, you can send the claim by mail or electronically, but we have not received it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] But last time I had sent uh through electronically 64556 is a payer ID, but did not receive uh to insurance OK.
[AGENT][NEUTRAL] Yeah, we have not received that claim. We did not have that claim on file.
[CUSTOMER][NEUTRAL] Have
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK. Your name, please?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] And the first initial of my last name is [PII].
[CUSTOMER][NEUTRAL] I my life out with me.
[CUSTOMER][NEUTRAL] OK, and call reference number?
[AGENT][NEUTRAL] Would be my name in today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Main last bit, OK.
[CUSTOMER][NEUTRAL] OK, please confirm the member ID is 2556561. Is that right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, and group number is 70019.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] OK, thank you for your assistance. Have a nice day.
[AGENT][POSITIVE] It was a pleasure to assist you, [PII]. Is there anything else I can help you with before you go?
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][POSITIVE] No, thank you for your assistance.
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Thank you for calling. I hope you have a wonderful day. Have a nice day.
[AGENT][POSITIVE] You too, May. Thank you.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Yeah