AccountId: 011433970860
ContactId: cdbce688-6105-4ab7-8990-91b206f33ad6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 566880 ms
Total Talk Time (AGENT): 152681 ms
Total Talk Time (CUSTOMER): 302103 ms
Interruptions: 6
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/cdbce688-6105-4ab7-8990-91b206f33ad6_20250604T20:58_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey.
[CUSTOMER][NEUTRAL] Yeah, hi, I'm [PII]. I'm calling from provider's office regarding our claims.
[AGENT][NEUTRAL] OK, I can verify claim status for you, [PII], and what is the policy number?
[CUSTOMER][NEUTRAL] The policy number is 02353094 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] OK, thank you and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII] with an extension of [PII].
[AGENT][NEUTRAL] OK, thank you. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Patient's first name is going to be [PII] and the last name is [PII], and the date of birth is going to be [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] The date of service is going to be it's [PII] with the bill amount of $2610 even.
[AGENT][NEUTRAL] OK, and the balance after primary?
[CUSTOMER][NEUTRAL] Uh, I'm sorry?
[AGENT][NEUTRAL] What is the balance after the primary?
[CUSTOMER][NEUTRAL] OK. After primary pay, the balance amount is 352 dollars.80 cents.
[AGENT][NEUTRAL] OK, thank you. Well, [PII], I do not show we've received that claim. Can you verify the mailing address it was submitted to?
[CUSTOMER][POSITIVE] Yeah, sure, definitely, ma'am.
[CUSTOMER][NEUTRAL] Upon checking, the claim was submitted. Oh my [PII], the claim was submitted to the [PII]. This is the mailing address is correct?
[AGENT][NEUTRAL] Uh, no, that address, um, it's no longer active as of [PII], so when you're ready I can give you the correct mailing address.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Sure, please.
[AGENT][NEUTRAL] OK, it is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, could you please send me the payer ID if you have any electronic payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 60801. Got it. So can you please help me in providing the uh
[CUSTOMER][NEUTRAL] Member effective and effective and termination there policy please.
[AGENT][NEUTRAL] Effective date [PII] I'm sorry, [PII] and the policy is active.
[CUSTOMER][NEUTRAL] [PII]. Got it and still active.
[CUSTOMER][NEUTRAL] OK. Could you please may I know what is the timely filing limit to submit the claim, claim?
[AGENT][NEGATIVE] Uh, there's no timely filing.
[CUSTOMER][NEUTRAL] Sure, got it.
[CUSTOMER][NEUTRAL] Could you please help me the qualify for this claim? And I do have 2 more claims. It's for 2 different numbers. Will you be able to provide the status?
[AGENT][NEUTRAL] Sure. Uh, we don't give call reference numbers. If you like, you may use my name at today's date.
[CUSTOMER][NEUTRAL] Yeah, I mean, can you spell your name with the last name for documentation purpose, please, ma'am.
[AGENT][NEUTRAL] [PII] last initial [PII].
[CUSTOMER][NEUTRAL] It's [PII]. Got it. Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I will help with the next number ID.
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Pres.
[AGENT][NEUTRAL] OK, uh, what is next policy number?
[CUSTOMER][NEUTRAL] The next policy number is going to be uh
[CUSTOMER][NEUTRAL] It is 01843884 M as in Mike, L as in Lima.
[CUSTOMER][NEUTRAL] Number 8.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Yeah, patient's first name is going to be.
[CUSTOMER][NEUTRAL] It's [PII] and the last name is [PII] and the date of birth is [PII]. Uh yeah.
[AGENT][NEUTRAL] OK, and date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, the service is going to be [PII] with a bill amount of $2,862 even.
[AGENT][NEUTRAL] OK, and the balance after primary?
[CUSTOMER][NEUTRAL] The balance after the primary is is.
[CUSTOMER][NEUTRAL] $87. 70 cents.
[AGENT][NEUTRAL] And you said the date of service was [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, we have not received that claim.
[CUSTOMER][NEUTRAL] OK, let me check from my end.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me check from my end whether which oh my [PII], I'm sorry, ma'am. I'm have haven't seen that this is the address which is incorrect. It was not yet updated, OK, in this case the pay ID also see right 60801 mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] May I know, could you please help me the member effective and terminations of policy, please.
[AGENT][NEUTRAL] Sure, uh, effective date is [PII] and the policy is active.
[CUSTOMER][NEUTRAL] You want.
[CUSTOMER][NEUTRAL] Got it. OK. Shall we move to another last thing?
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] No, that's up.
[AGENT][NEUTRAL] OK, what is the uh last policy number?
[CUSTOMER][NEUTRAL] Last policy number is going to be it's 02295946 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] OK, and patient's name, date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is uh [PII] and the last name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, data service amount of the charge.
[CUSTOMER][NEUTRAL] Uh, uh.
[CUSTOMER][NEUTRAL] The date of service is going to be it's [PII]. It's [PII] with the bill amount of.
[CUSTOMER][NEUTRAL] $348 even.
[CUSTOMER][NEUTRAL] Mhm. Yeah, after I balance the primary.
[AGENT][NEUTRAL] OK, and the balance after primary?
[CUSTOMER][NEUTRAL] The balance amount is $60 even.
[AGENT][NEUTRAL] OK, one moment and what is the name [PII]f the provider's office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The name of the provider's office is Gastro Health LLC.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] 7
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh, show that claim process as office visits are not covered per the policy.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK. You're stating that you have been issued the claim, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Mhm. May I know when the claim has been received? May I know when the claim has received and denied?
[AGENT][NEUTRAL] Claim received [PII], process on [PII].
[CUSTOMER][NEUTRAL] M
[CUSTOMER][NEUTRAL] [PII] I guess stating that outpatient offices are not covered on this member's plan, right.
[AGENT][NEUTRAL] Office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] OK. Could you please help me with the member's policy name?
[AGENT][NEUTRAL] Medlink
[CUSTOMER][NEUTRAL] R.
[CUSTOMER][NEGATIVE] Mali.
[CUSTOMER][NEUTRAL] That for us.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] In this case, can you send me the copy of Denaio B through fax? Is it possible?
[AGENT][NEUTRAL] Sure, what's the fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and that is [PII]?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and is there anything else, [PII], I can assist you with today?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah, can you help me the claim number Binar claim number, please?
[AGENT][NEUTRAL] 359-715-9.
[CUSTOMER][NEUTRAL] 5.
[CUSTOMER][NEUTRAL] It's 359-7159. This is the key number. Got it. Uh-huh. OK, that's all the information I needed. Thank you for your assistance. Uh-huh. Bye for now.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APO bye.
[CUSTOMER][NEUTRAL] Mhm.