AccountId: 011433970860
ContactId: cabcdbcd-1b0a-4997-b651-7d022a1bb74a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 697780 ms
Total Talk Time (AGENT): 253518 ms
Total Talk Time (CUSTOMER): 227252 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/cabcdbcd-1b0a-4997-b651-7d022a1bb74a_20250331T17:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from office regarding claims.
[AGENT][NEUTRAL] OK, yeah, I can check on a claim for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Callback number [PII] direct line or extension. And could you spell out your name?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, it's [PII]
[CUSTOMER][NEUTRAL] And first name last name.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Of course. And then did you have that policy number?
[CUSTOMER][NEUTRAL] Yes, 024852, 255 ML 7.
[AGENT][NEUTRAL] OK and uh what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] [PII] and the date of birth, [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that [PII] uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Um, data service will be [PII] charger on $1200 even.
[AGENT][POSITIVE] Got it thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, let's see, was that remaining balance after major medical paid, um, was that $337.43?
[CUSTOMER][NEUTRAL] Yes, uh, primary process towards, uh, patient deductible amount.
[AGENT][NEUTRAL] For $337.43 correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so we did pay that benefit. [PII], give me just a moment I'll get that information for you.
[AGENT][NEUTRAL] OK, I've got that claim number whenever you're ready.
[CUSTOMER][POSITIVE] Yes, I'm ready for that.
[AGENT][NEUTRAL] OK, claim number is 3541643.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that claim was received [PII].
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then I've got that check number as [PII].
[AGENT][NEUTRAL] 541.
[AGENT][NEUTRAL] That check was issued [PII] and I am showing that it has not yet cleared so we can get that voided and reissued whenever you're ready I can verify the address that we have for that to be sent to.
[CUSTOMER][NEUTRAL] OK, um, before that, how much you pay for this claim?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] $337.43
[CUSTOMER][NEGATIVE] Mm, with no patient responsibility.
[AGENT][NEUTRAL] That's the benefit amount that we paid we don't say what is patient responsibility.
[CUSTOMER][NEUTRAL] OK. And may I know what is the pay to address you paid for the claim?
[AGENT][NEUTRAL] That was [PII], zip code [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I will go ahead and get this check voided and reissued. Uh, was there any other information I could provide you with?
[CUSTOMER][NEUTRAL] Uh no, uh, that's all. And could you send me a, a copy of a UB to my fax number?
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Of course, absolutely. What was that fax number?
[CUSTOMER][NEUTRAL] [PII] and attention to my first name, [PII], and my initial S as in [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm gonna read that number back to you to make sure I heard that correctly. That was [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alright, I will go ahead and get that sent to you. You should get it here within about 10 minutes or so.
[AGENT][NEUTRAL] Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] No, that's all. Uh, are you going to void the check and going to reissue again?
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And when will you reissue that check?
[AGENT][NEUTRAL] I'm going to go ahead and get that put in now. It might take a few days for it to process.
[CUSTOMER][NEUTRAL] Few days to process, OK.
[CUSTOMER][POSITIVE] OK, thank you so much and can I get the call reference number?
[AGENT][POSITIVE] Of course, thanks for calling APL.
[AGENT][NEUTRAL] Yeah, it would just be my first name, last initial, and today's date.
[CUSTOMER][NEUTRAL] OK, and one moment, let me check if I have any other data service for the same patient.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's the date for [PII]. I have two more data servers for the same patient. Can you help me with that?
[AGENT][NEUTRAL] Same number.
[AGENT][NEUTRAL] Yes, OK, um, let's see, what was that next date of service?
[CUSTOMER][NEUTRAL] Next date of service [PII]. Charge amount $175.02.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm OK.
[AGENT][NEUTRAL] OK, I'm not showing that we received a claim for that date of service for this number.
[CUSTOMER][NEUTRAL] No claim for [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and may I know your mailing address to resubmit the claim?
[AGENT][NEUTRAL] Yes, that is [PII].
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][POSITIVE] OK, thank you so much and one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We um.
[CUSTOMER][NEUTRAL] And the timely filing for the initial claim.
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][NEUTRAL] Not the limit, OK, and the payer ID.
[AGENT][NEUTRAL] That is 60801.
[CUSTOMER][POSITIVE] 60801. OK, thank you so much.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Alright, and can we move to the next state of service for the same patient.
[AGENT][NEUTRAL] Yes, what was that next day of service?
[CUSTOMER][NEUTRAL] Like state of services.
[CUSTOMER][NEUTRAL] [PII] charge on $125 even.
[AGENT][NEUTRAL] 125. OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so for this claim, [PII], we did receive it. We were unable to pay that benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] Offices is not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Only you pay for the surgery.
[CUSTOMER][NEUTRAL] Cos
[AGENT][NEGATIVE] Yeah office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] And may I know the patient plan effective date and term date?
[AGENT][NEUTRAL] Effective date was [PII].
[AGENT][NEUTRAL] And that term date was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and the patient plan type?
[AGENT][NEUTRAL] It is a secondary medical policy.
[CUSTOMER][NEUTRAL] Check under the medical policy. One moment.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, and uh may I know when this claim received and denied?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] This claim was received [PII], and it was processed [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the claim number?
[AGENT][NEUTRAL] That claim number is 3541.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 648.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then what are the policy, uh, what are the service will cover under this policy?
[AGENT][NEUTRAL] It does cover a wide number of things, uh, again, mainly like outpatient surgery. It's just office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, no problem, and can I get the call reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial and today's date.
[AGENT][NEUTRAL] Uh, was there anything else I could help you with?
[CUSTOMER][POSITIVE] Oh, OK, thank you so much.
[CUSTOMER][NEUTRAL] Mm, I need um.
[CUSTOMER][NEUTRAL] Copy of the for this claim also.
[AGENT][NEUTRAL] The other one as well? OK.
[AGENT][POSITIVE] Alrighty I will get that sent to you as well.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right. You should be getting that one within about 10 minutes as well.
[AGENT][NEUTRAL] Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, that's uh
[AGENT][POSITIVE] Alright, well thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] 44
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.