AccountId: 011433970860
ContactId: cb4214e2-30c1-45a7-b78d-acfc49322ff0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 523658 ms
Total Talk Time (AGENT): 111974 ms
Total Talk Time (CUSTOMER): 182217 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/cb4214e2-30c1-45a7-b78d-acfc49322ff0_20250425T19:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm looking for medical claim status.
[AGENT][NEUTRAL] Hey, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] And the policy number of the patient?
[CUSTOMER][NEUTRAL] Yes, 01979893 M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Yes, first name is [PII]. Last name is [PII]. And date of the [PII].
[AGENT][POSITIVE] Day of service and build them out.
[CUSTOMER][NEUTRAL] Uh, [PII] and the total charges $14,368 even.
[AGENT][NEUTRAL] OK, it looks like we received that 11-12 2024. Proceed 11-14, 2024.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] It looks like we needed the primary explanation of benefits.
[CUSTOMER][NEUTRAL] Uh yes. Uh, the primary will be sent on [PII]. We sent through fax. The fax number is [PII]. Is that correct fax number?
[AGENT][NEUTRAL] Yes, it takes a while for that to get in the system, typically up to 5 working days, so I don't have it in the system yet.
[AGENT][NEUTRAL] Might check back on Monday or Tuesday.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. I will resubmit. Uh, do you have the claim number?
[AGENT][NEUTRAL] Claim number 353-0245.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. Do you have any alternate fax number?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, OK. I will resubmit the same fax number. Any time limit for resubmit the primary OP any time?
[AGENT][NEUTRAL] No, there's not.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, I have 2 more claims. Are you able to assist other two claims. It's a different patient.
[AGENT][NEUTRAL] Uh yes, give me one moment.
[CUSTOMER][POSITIVE] Yeah, sure. Thank you.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] OK, do you have the policy number for the next patient?
[CUSTOMER][NEUTRAL] Yes, 01653909, M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Yes, first name is [PII] and last name is [PII]. And date of birth is [PII].
[AGENT][NEUTRAL] And the date of service and bill charges?
[CUSTOMER][NEUTRAL] Uh yes. Uh, [PII]. And the total charges $38,215 even.
[AGENT][NEUTRAL] No, it's received 2-11-2025. Proceed 213-2025, needing the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Uh, this one we send on [PII]. We submit through the mailing address is [PII].
[CUSTOMER][NEUTRAL] Uh, MS [PII]. Is that correct mailing address?
[AGENT][NEGATIVE] No, that's incorrect.
[CUSTOMER][NEUTRAL] OK. May I have your current fax number? Please submit through fax?
[AGENT][NEUTRAL] Uh, the fax is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, may I have the claim number?
[AGENT][NEUTRAL] My number is 3563409.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Uh, shall I move to last claim?
[AGENT][NEUTRAL] Uh, give me one moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what's that last claim number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, claim number or policy number? What do you mean?
[AGENT][NEUTRAL] I'm sorry, uh, policy number, sorry about that.
[CUSTOMER][NEUTRAL] Uh yeah, sure. It's 02465901.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Yes. Uh,
[CUSTOMER][NEUTRAL] The first name is [PII], last name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] And date of service and bill charges?
[CUSTOMER][NEUTRAL] [PII]. And the total charge is $27,307 even.
[AGENT][NEUTRAL] OK, looks like we received this on.
[AGENT][NEUTRAL] 99 2024 process 9-132024 and it says.
[AGENT][NEUTRAL] Benefits are only payable if major medical insurance provides benefits. If it's later processed by major medical, please provide explanation of benefits showing it was paid.
[CUSTOMER][NEUTRAL] This also need the primary, right?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, showing that the claim was considered and processed and paid by primary.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. Uh, this one we sent [PII], we submit to corrected claim. Could you verify the backside of the claim form we attached to primary ID?
[AGENT][NEUTRAL] Um, let me check.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it looks like all that we received was the UBO4, so we all we received was the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. No problem. uh, may I have the claim number?
[AGENT][NEUTRAL] 356-2235.
[CUSTOMER][NEUTRAL] 235.
[CUSTOMER][NEUTRAL] The same fax number, right? Previously, provide the same fax number. Yes.
[AGENT][NEUTRAL] Yes, that's
[CUSTOMER][NEUTRAL] Uh, do you have any caller reference number, [PII]?
[AGENT][NEUTRAL] Uh, it's just my name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK. Thank you. Thank you for your assistance. Have a good day.
[AGENT][POSITIVE] Thanks for calling APL you as well.
[CUSTOMER][NEUTRAL] Yeah, bye.
[AGENT][NEUTRAL] Yeah.