AccountId: 011433970860
ContactId: c67037c5-822c-4cdc-a020-08d6f0520699
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 445029 ms
Total Talk Time (AGENT): 148919 ms
Total Talk Time (CUSTOMER): 232453 ms
Interruptions: 8
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/c67037c5-822c-4cdc-a020-08d6f0520699_20250429T20:21_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider office. Um, regarding this call, I'm looking for general claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status, [PII]. And may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Callback number [PII].
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you for that and the policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Yes, I'm ready. And policy number is 01829142.
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Yeah, I have only one.
[AGENT][NEUTRAL] Alright, and can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. Ma's first and last name is [PII].
[CUSTOMER][NEUTRAL] There you go.
[CUSTOMER][NEUTRAL] Mm yeah.
[AGENT][NEUTRAL] And date of birth?
[CUSTOMER][NEUTRAL] Date of birth. Just hold for a second.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the member's date of birth is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So it's for
[AGENT][NEUTRAL] What's the member's first and last name because that date of birth is for a different member on this policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's [PII] and the last name [PII]. And date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So this um family does not have a dental policy. This is a secondary medical policy. Um, so you would need to reach out to the member to see who their dental insurance is through, um, but we, we don't provide that for them.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] I call.
[CUSTOMER][NEUTRAL] No, I'm looking for medical benefits and for the data service, 1227-24. The total charge amount is $8,648.
[AGENT][NEUTRAL] Hold on 1 2nd, hold on 1 2nd. Hold on.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So this is a medical claim because it in the beginning, I thought you said dental claim status. It's medical.
[CUSTOMER][NEUTRAL] Yes, medical
[AGENT][NEUTRAL] OK, and what's the date of service?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] $8,648.
[AGENT][NEUTRAL] $8,648?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] The facility name is Kendal Anesthesia Associates.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] So I'm trying to received the claim on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3558921.
[CUSTOMER][NEUTRAL] H Q E
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] So you have not received any primary for this member?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Um, just hold a second.
[CUSTOMER][NEUTRAL] And can you provide me the mailing address or fax number so we can fax the primary year before this one.
[AGENT][NEUTRAL] Sure, our claims mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's, I'm sorry, that's APL claims department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Our payer ID is 60801.
[CUSTOMER][NEUTRAL] 60801. And is there any tax number do you have?
[AGENT][NEUTRAL] Mhm. Our fax number is [PII].
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] And that's attention APL claims department.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] And so what is the timely time limit?
[AGENT][NEUTRAL] There's no timely filing limit as long as the policy is active on the data service, you can file the claim at any time, and this policy was active.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] The back pain.
[CUSTOMER][NEUTRAL] Yeah, OK. So we need to put attention APA.
[AGENT][NEUTRAL] For the fact, yes, attention APL claims department.
[CUSTOMER][NEUTRAL] APA Claims Department.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] And once again, can you provide me the fax number?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 942 3. Yeah, OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah, OK, thank you. And can I have your name and call reference number?
[AGENT][NEUTRAL] Yes, my name is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm. And can I have the call reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date.
[CUSTOMER][NEUTRAL] No, you don't
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Yeah, OK, thank you, [PII]. Thanks for helping and have a nice day.
[AGENT][POSITIVE] You're welcome. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Yeah, no, thank you. That's it for today.
[AGENT][POSITIVE] Alright, thanks for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, you too. Bye bye.
[AGENT][NEUTRAL] Bye bye.