AccountId: 011433970860
ContactId: ceca3435-3d78-4bf0-9331-7661b5638197
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 431690 ms
Total Talk Time (AGENT): 155021 ms
Total Talk Time (CUSTOMER): 135349 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/ceca3435-3d78-4bf0-9331-7661b5638197_20250527T12:54_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi. Uh, no, my name is [PII]. I'm calling from provider's office to check on a claim status.
[AGENT][POSITIVE] OK, well I'll be more than happy to help you with the claim status, [PII], and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Only one.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, my callback number is [PII].
[AGENT][NEUTRAL] And the policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Yes, policy number is 60.
[CUSTOMER][NEUTRAL] 801.
[AGENT][NEUTRAL] So that's our payer ID number. Do you have the ID card there with you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, you're looking for the in-hospital or outpatient policy er number or it may just say policy cert number?
[AGENT][NEUTRAL] You you start with the 0102?
[CUSTOMER][NEUTRAL] Mhm, just a second.
[CUSTOMER][NEUTRAL] OK. Is that uh member ID which I, I have provided that is wrong.
[AGENT][NEUTRAL] That's our payer ID. That's how you submit electronic payments. I'm trying to help you locate the policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, just a second, I'll take.
[AGENT][NEUTRAL] I can also search the.
[CUSTOMER][NEUTRAL] OK, I could see that.
[AGENT][NEUTRAL] You have it?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I, uh, in a member ID it is showing group number. Can I provide that?
[AGENT][NEUTRAL] Yes, I can search from the group number and then the patient's first and last name. What do you see for the group number?
[CUSTOMER][NEUTRAL] Yes, 26521.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And what's the member's first and last name?
[CUSTOMER][NEUTRAL] My name is uh [PII].
[AGENT][NEUTRAL] Can you spell the last name for me, please?
[CUSTOMER][NEUTRAL] Yes. [PII].
[AGENT][NEUTRAL] OK, I have it here and the member's date of birth?
[CUSTOMER][NEUTRAL] Yes, the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So the policy number is 250.
[AGENT][NEUTRAL] 1618.
[CUSTOMER][NEUTRAL] I'm
[AGENT][NEUTRAL] And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Yes, date of service is uh [PII]. Total charge amount is $1,313.63.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah it looks like that
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yes, provider's name is PHD Jackson Memorial Hospital.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 359.
[AGENT][NEUTRAL] 92
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 41
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Proceed all.
[AGENT][NEUTRAL] And on [PII]
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On [PII], OK, hold on one moment.
[CUSTOMER][POSITIVE] Yes, got it.
[AGENT][NEUTRAL] On [PII], we processed the claim.
[CUSTOMER][NEUTRAL] I
[AGENT][NEGATIVE] And it was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. I do have uh you be from the primary insurance. How can I submit that?
[AGENT][NEUTRAL] Um, you can mail it, you can fax it, or you can send it electronically with the payer ID. Um, did you need our mailing address or fax number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Did you prefer one or the other or you want both?
[CUSTOMER][NEUTRAL] I need both.
[AGENT][NEUTRAL] OK, I'm sorry, claims mailing address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, just a second.
[CUSTOMER][NEUTRAL] Uh, what's the ZIP code number?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] And our fax number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 877.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942 [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's attention
[CUSTOMER][NEUTRAL] OK. Uh, that is 877.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Uh yeah, I'll confirm the fax number that is [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, what is the time finding limit to submit?
[AGENT][NEUTRAL] Did you need the attention for the facts?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's attention APL claims department.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And there's no timely filing limit as long as the policy was active on the data service. You can file at any time.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] I got it. Um.
[CUSTOMER][NEUTRAL] I'm done. What's uh call reference?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. Thank you so much for your help and patience. Have a great day. Take care. Bye-bye.
[AGENT][POSITIVE] You're welcome. Was there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] No, [PII], that's it.
[AGENT][POSITIVE] Alright, thanks for calling APO have a good day bye bye.