AccountId: 011433970860
ContactId: cbec43b3-eeac-45df-8291-2f29d44cb1ba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 345049 ms
Total Talk Time (AGENT): 198879 ms
Total Talk Time (CUSTOMER): 105072 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/cbec43b3-eeac-45df-8291-2f29d44cb1ba_20250213T17:38_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from my psychiatrist to check the claim status.
[AGENT][POSITIVE] Alright, [PII], be glad to help you. Go ahead and give me a good policy number, please.
[CUSTOMER][NEUTRAL] Um, yeah, sure. The policy number will be 01622812 M like Mike L like Lima 8.
[AGENT][POSITIVE] All [PII], [PII], thank you so much for that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number, please, ma'am.
[CUSTOMER][NEUTRAL] Yeah. It's [PII]. It's a direct line.
[AGENT][POSITIVE] All right, [PII], thank you so much for that information. Now, your patient's name and date of birth today, please?
[CUSTOMER][NEUTRAL] A patient name will be [PII] and date of birth is on [PII].
[AGENT][NEUTRAL] All [PII], [PII], thank you so much for that information. Looks like [PII] is the insured on this medical supplemental plan, and you did say you want to check status of a claim. Is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Data service [PII].
[CUSTOMER][NEUTRAL] Um, the data service, uh, just give me a second. The data service is for [PII] with the bill amount $15,550 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, [PII], let me do some checking. Let's see if we have your claim 16.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] I don't see anything processed for 16, so let me, I do see a claim here in line for processing so let me go and look at it right quick and let's just make sure that's not it so bear with me just a moment, [PII], let me do some research. Let's see.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] And you did say that charge was $150 total, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, let's see.
[AGENT][NEUTRAL] Bear with me, [PII], my computer is just spinning, so bear with me just a moment, hopefully it will come up in just a second. Here we go. Let's see.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Yeah, no issues, take your time.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] No, ma'am, this is not your claim, so we have not received that claim for [PII] here at all.
[AGENT][NEUTRAL] You want to fax it over or when did you mail it?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, we mailed it to the address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, yes ma'am, that PO box closed about 2 years ago, so let me give you the correct mailing address now so you can go ahead and get that claim resubmitted to APL. We do not have a timely filing limit, so you're good to go with refiling it, but let's get your uh address updated to the uh current PO box which is going to be [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And our zip here is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, and may I also know the payer ID please?
[AGENT][NEUTRAL] Yes, ma'am, and you can electronically submit it, which would be way faster. So that payer ID number is 60801.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Oh, great. Thank you so much for that. As you before stated that there is no time following limit to submit a claim, am I right?
[AGENT][NEUTRAL] OK. Yes, ma'am.
[AGENT][POSITIVE] Correct, that is correct, [PII], and is that all I can help answer for you today?
[CUSTOMER][NEUTRAL] Uh-huh. Uh, do you have the fax first to submit a claim?
[AGENT][NEUTRAL] I'm sorry, what was your question, [PII]?
[CUSTOMER][NEUTRAL] Uh, do you have the fax facility to submit a claim?
[AGENT][NEUTRAL] Yes, you can fax your claim and make sure you fax a copy of the original bill along with that primary EOB as we are just a supplemental plan here but you can fax it to one.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 877.
[AGENT][NEUTRAL] 3659423 put attention claims department.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Oh yeah, great. Thank you so much for your assistance. And before that, I would also note, uh, that is this member's plan is active for the data service?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am, [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Oh great thank you so much for your assistance. Can I get the call reference number please?
[AGENT][NEUTRAL] We do not give call for summer, Kay, but you can use my name in today's date and my name is [PII]
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Oh great, thank you so much, [PII], for your assistance. Have a great day. Bye for now. Stay safe.
[AGENT][POSITIVE] You as well. Yes, ma'am. You as well. Thanks for calling APL [PII]. Bye-bye.