AccountId: 011433970860
ContactId: cc797613-b9f6-44d4-aaec-f2b9b48c5597
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 749929 ms
Total Talk Time (AGENT): 174534 ms
Total Talk Time (CUSTOMER): 283025 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/cc797613-b9f6-44d4-aaec-f2b9b48c5597_20250422T13:12_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning, sir. My name is [PII]. I'm calling from Pror's office, checking out a claim status for patients.
[AGENT][NEUTRAL] Sure, I can assist you with claim status, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. The callback number is going to be?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII], a direct line.
[AGENT][NEUTRAL] OK. May I have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] I'm calling from Miami Beach Community Health.
[AGENT][NEUTRAL] Community Health Hospital.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Or community health clinic or.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's a combination of clinics.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] The member number is gonna be 60801.
[AGENT][NEUTRAL] OK, that's our payer ID. Do you see a policy certificate number?
[CUSTOMER][NEUTRAL] No, I said this, this is the member ID number in my 60801.
[AGENT][NEUTRAL] That's the payer ID.
[AGENT][NEUTRAL] Mr. [PII], that's a payer ID. That's not a policy. Do you have the copy of the card?
[CUSTOMER][NEUTRAL] One moment, let me double check in my end. Just bear with me.
[AGENT][NEUTRAL] OK. Sure.
[CUSTOMER][POSITIVE] Thank you. I appreciate that.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah, I, I found the patient, uh patient ID card. One moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. I checked in and uh it will be only showing the uh patient ID card. Uh the pay ID number is 60801 and the group number. There is no number ID found in my.
[AGENT][NEUTRAL] OK, do you see a policy certificate? It's gonna be outpatient cert in the bottom of that card. There's 2 numbers, inpatient, outpatient cert. I just need one of those.
[CUSTOMER][NEUTRAL] All right. Uh, the inpatient hospital benefits for the number is gonna be 0233.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 603.
[CUSTOMER][NEUTRAL] 9 M. like Mike L like Lima 7.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The patient's first name, [PII]. The last name [PII]. Date of birth [PII].
[AGENT][NEUTRAL] May I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII], the total charge amount, $20 even.
[AGENT][NEUTRAL] OK, right, 25 of 25 for 20. Let me see if I can find that claim.
[AGENT][NEUTRAL] And Mr. [PII], uh, for future, you can check claim status online through our website at [PII], and that's just optional.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] And we don't have that claim. We have not received that claim as of today.
[CUSTOMER][NEUTRAL] One moment, let me double check.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right, I checked my, uh.
[CUSTOMER][NEUTRAL] I just verify the pay right now.
[CUSTOMER][NEUTRAL] All right. Uh, if you don't mind, can I put you for a second?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. Uh, thank you so much for holding. Uh, I checked in my I uh the claim must be submitted through to paper.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, could you please verify the address? Uh,
[AGENT][NEUTRAL] Where was it sent to?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, the claim has been sent to [PII].
[AGENT][NEUTRAL] OK, that's an old address.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, I think maybe the address has been updated in your end, right?
[AGENT][NEUTRAL] The address is different and you have an old address.
[CUSTOMER][NEUTRAL] All right. One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, you mentioned that there is no claim on file. Uh, so may I know the, uh, base 50 date?
[AGENT][NEUTRAL] No, no, I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] Could you please confirm the patient effective date?
[AGENT][NEUTRAL] Yes, uh-huh.
[AGENT][NEUTRAL] Yes, the effective date, let's see, that's going to be [PII].
[AGENT][NEUTRAL] [PII]. It is active at the moment and this is a secondary supplemental plan to the major medical. And do you need the address, Mr. [PII]?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] And you mentioned that the business is active from uh [PII] and still active, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Perfect. And could you please confirm the time of the file number to submit the claim.
[AGENT][NEUTRAL] We don't have timely filing limits. Do you need the new address?
[CUSTOMER][NEUTRAL] You mentioned there is no time limit to submit the client?
[AGENT][NEUTRAL] Correct. Do you need the mailing address to submit the claim, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yeah, one moment. Let, let me document in my, just bear with me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Alright, could you please confirm the uh transmitting address?
[AGENT][NEUTRAL] Sure, that's [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Alright, one moment.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And uh you mentioned the pay ID number 60801. Am I right?
[AGENT][NEUTRAL] That is correct. Now, this claim needs to be faxed or mailed because it's a secondary, and we need the primary E will be attached to i[PII]
[AGENT][NEUTRAL] Do you need the fax number?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Alright, uh, uh, we don't need a fax number because we guys, uh, 1 to 2 options like, uh, you guys send it to the electronic or mailing, uh, you guys, uh, preferred as a mailing, right? People time, right?
[AGENT][NEUTRAL] Correct, yes, because we need the copy of the explanation of benefits. Mhm.
[CUSTOMER][NEUTRAL] All right
[CUSTOMER][NEUTRAL] For the primary, all right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thanks so much information. I appreciate it.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] And uh for the information I have one more client for the same patient with different data servers.
[CUSTOMER][NEUTRAL] Could you please help me for it?
[AGENT][NEUTRAL] OK, let me make a note on this 11 moment.
[CUSTOMER][NEUTRAL] Sure. Once if you're ready, I can provide the the next day service for the same.
[AGENT][NEUTRAL] Is it the same member or is it, is it a different member, Mr. [PII]?
[CUSTOMER][NEUTRAL] Uh, it, it is the same member for the different data service.
[AGENT][NEUTRAL] OK, what is the date of service?
[CUSTOMER][NEUTRAL] [PII], the total charge amount, $275.08.
[AGENT][NEUTRAL] No claim on file for that data service.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Let me double check the claim must be send it to the same address or not. All right. I think that the claim must be submitted to the same address like old address. So you already mentioned that the patient is from [PII] and still active and there is no time limit to submit the claim. And uh the mailing address is [PII].
[CUSTOMER][NEUTRAL] [PII] [PII]. And the payer ID is 0801. So you guys need a primary EOB with the client because uh
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] American Public Life as a secondary for this member, right?
[AGENT][POSITIVE] OK, correct.
[CUSTOMER][POSITIVE] All right, perfect. Thank you so much for your information. And uh could you please confirm the reference number?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's state if you would like.
[CUSTOMER][NEUTRAL] All right. And your name, uh,
[AGENT][NEUTRAL] My name is So. Yes. Mhm.
[CUSTOMER][NEUTRAL] So right, so.
[CUSTOMER][NEUTRAL] Sorry, I missed your name. Like your name is [PII], or?
[AGENT][NEUTRAL] No, it's all. [PII].
[CUSTOMER][NEUTRAL] So, all right.
[CUSTOMER][POSITIVE] I get it. Thank you so much for your information. I appreciate that. Have a great day as well. And bye.
[AGENT][NEUTRAL] No, I
[AGENT][NEUTRAL] You as well.
[AGENT][NEUTRAL] Bye bye.