AccountId: 011433970860
ContactId: d7e07b76-e1b1-499f-87f0-3ea92edb2766
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 279799 ms
Total Talk Time (AGENT): 84818 ms
Total Talk Time (CUSTOMER): 98372 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/d7e07b76-e1b1-499f-87f0-3ea92edb2766_20250409T16:54_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, this is [PII]. How can I help you? Hi, this is [PII] calling from Memorial Hospital to check our claim status.
[AGENT][NEUTRAL] Hey [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Sure. That is [PII]. It's a [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yeah, the member ID is 02003015 M Mary L Lima number 8.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] If
[CUSTOMER][NEUTRAL] Member's name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the date of service.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The date of service is [PII] for $1,694 even.
[AGENT][NEUTRAL] Um, I don't show a claim on file for that date.
[AGENT][NEUTRAL] Let me see though.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] I, mhm.
[AGENT][NEUTRAL] I think this is an old policy. Let me double check and see if she has a new one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, yes, that was an old policy that she that you gave me. So let me pull up her new one.
[CUSTOMER][NEUTRAL] Mhm sure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hey, I look through it.
[AGENT][NEUTRAL] What was the bill amount?
[CUSTOMER][NEUTRAL] That is $1,694 even.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] OK, thank you
[AGENT][NEUTRAL] OK. Looks like we received that on 125-2024. Process 12-6-2024.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can I get the claim number?
[AGENT][NEUTRAL] 353-813-7
[AGENT][NEUTRAL] Uh, benefits are payable only if major medical insurance provider provides benefits.
[AGENT][NEUTRAL] That has to be considered by major medical.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mhm so this got denied, right?
[AGENT][NEUTRAL] Yes, because the major medical explanation of benefits didn't show that the claim was processed.
[CUSTOMER][NEUTRAL] So you do not have the uh primary explanation of benefits information listed, is that right?
[AGENT][NEUTRAL] We have it, but it didn't show any benefits were payable on it, so.
[CUSTOMER][NEUTRAL] Uh huh. Got it. In that case, I can send the primary explanation of benefits. May I get the mailing address to submit the primary EOB?
[AGENT][NEUTRAL] Mailing address is [PII].
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Also may I get the timely filing limit?
[AGENT][NEGATIVE] Uh, there's no timely filing limit.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Also make it the member's policy effective rate and term rates for my documentation.
[AGENT][NEUTRAL] Um, that is.
[AGENT][NEUTRAL] Effective [PII], policy is active.
[CUSTOMER][NEUTRAL] She
[CUSTOMER][POSITIVE] Perfect thank you so much for your assistance and patience. May I get the call reference number?
[AGENT][NEUTRAL] That's just my name, [PII], first initial to last name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK thank you so much for that again you have a great day.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day too.