AccountId: 011433970860
ContactId: dac8b5e2-7f79-4f34-a002-0f0351ecd58e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 945119 ms
Total Talk Time (AGENT): 211071 ms
Total Talk Time (CUSTOMER): 257892 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/dac8b5e2-7f79-4f34-a002-0f0351ecd58e_20250616T13:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. This is [PII] calling from provider office checking for the claim status.
[AGENT][NEUTRAL] All right, [PII], happy to check on a claim. What is the patient's policy number, please?
[CUSTOMER][NEUTRAL] Uh, yes, just a second.
[CUSTOMER][NEUTRAL] It's 02249087 M as in Mike, L as in Lima.
[CUSTOMER][NEUTRAL] 8
[AGENT][NEUTRAL] I have the patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] Just a second, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Patient's name is, it's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And then for documentation, do you have a good callback number, please?
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][NEUTRAL] What is the data service?
[CUSTOMER][NEUTRAL] Uh 131, 2024, 25.
[CUSTOMER][NEUTRAL] The amount is 15,2004, yeah, [PII] of this year, [PII].
[AGENT][NEUTRAL] Ja
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the bill amount is $15,204 even.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Not showing any claims on file for that bill amount.
[CUSTOMER][NEUTRAL] OK, patient is active in this retail service.
[AGENT][NEUTRAL] Uh yes. Policy effective date is [PII]. Patients still active.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Please provide me the mailing address to submit the claim.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, do you need me to spell?
[CUSTOMER][NEUTRAL] Uh City.
[CUSTOMER][NEGATIVE] Oh, yeah, no.
[CUSTOMER][NEUTRAL] [PII] short form is uh [PII], right? OK, sorry.
[AGENT][NEUTRAL] Yeah. [PII], zip code is [PII].
[CUSTOMER][NEUTRAL] 73224. OK. Payer ID and the mail uh timely filing?
[AGENT][NEUTRAL] Pay your ID is 60801.
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][POSITIVE] All right. Thank you so much.
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Actually, I just do more claim. Can you please help me with that one?
[AGENT][NEUTRAL] Another claim that you need me to check? Is that what you had said?
[CUSTOMER][NEUTRAL] Uh yeah, just a second. I just need to wrap up this. Uh, can you please provide me the order number for this one?
[AGENT][NEUTRAL] Call reference is my name with today's date. So my name again is [PII], last initial [PII], and then today's date.
[CUSTOMER][NEUTRAL] All right, just a second.
[CUSTOMER][POSITIVE] All right. Thanks for your patience. I really appreciate that.
[CUSTOMER][NEUTRAL] Uh, so the next one is?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 01
[CUSTOMER][NEUTRAL] 930
[CUSTOMER][NEUTRAL] 691 ML 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] or date, date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And then what is the date of service?
[CUSTOMER][NEUTRAL] Uh, date of service for this one is.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] To [PII]. The amount is $12,839 even.
[AGENT][NEUTRAL] Do you have a different amount after primary paid?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] It's showing that they are.
[CUSTOMER][NEUTRAL] $12,839 even. Yeah, we have this amount only.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This claim is received, it looks like on [PII].
[AGENT][NEGATIVE] It was denied on February.
[CUSTOMER][NEUTRAL] Just a second, sir.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, sorry for the interrupting. Actually I'm just writing it down here.
[CUSTOMER][NEUTRAL] Yeah, see you on February.
[AGENT][NEUTRAL] The claim was received on [PII].
[AGENT][NEUTRAL] It was denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Claim number?
[AGENT][NEUTRAL] 3,562,350.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It says speech or occupational therapy are not a covered benefit on the member policy.
[CUSTOMER][NEUTRAL] Claim is denied due to services not covered under the patient policy.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Is there no other plan active for this one?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Is there any patients facility?
[AGENT][NEUTRAL] We're not able to advise on patient responsibility that would be up to the facility or the provider.
[CUSTOMER][NEUTRAL] So can you please suggest me what should I do on this claim? Is there any?
[CUSTOMER][NEUTRAL] Suggestions for me?
[AGENT][NEUTRAL] No, I mean, we're the secondary insurance. It's not a covered benefit, so we're not able to advise.
[AGENT][NEUTRAL] On what the responsibility is that's up to the provider.
[CUSTOMER][NEUTRAL] OK. So for this one, I need to contact the patient to update the other plan.
[AGENT][NEUTRAL] Yeah, we don't know what that, yeah.
[CUSTOMER][NEUTRAL] If there is other plan.
[AGENT][NEUTRAL] Yeah, we don't have that information. You would have to contact the insured.
[CUSTOMER][POSITIVE] All right. Thank you so much. Just a second.
[CUSTOMER][NEUTRAL] Almost done for this one.
[CUSTOMER][NEUTRAL] Same call reference number, your name.
[AGENT][POSITIVE] Mhm, that is correct.
[CUSTOMER][NEUTRAL] Alright, uh, just a moment. I'm almost done for this one.
[CUSTOMER][NEUTRAL] OK. So the last 11.
[CUSTOMER][NEUTRAL] And then I'm done.
[AGENT][NEUTRAL] What is the next member ID?
[CUSTOMER][NEUTRAL] It's 246-2039.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is, it's
[CUSTOMER][NEUTRAL] [PII]'s date of birth is [PII].
[AGENT][NEUTRAL] Let me read back this policy number. I copy down 02462039.
[CUSTOMER][NEUTRAL] This is the correct uh payer ID for this one?
[AGENT][NEUTRAL] Did I copy that policy number correctly?
[CUSTOMER][NEUTRAL] Because I
[CUSTOMER][NEUTRAL] Uh, actually, I have just only 2462039.
[AGENT][NEUTRAL] 24
[AGENT][NEUTRAL] 62039. And what did you have as the name and date of birth?
[CUSTOMER][NEUTRAL] Uh, for this one, his name is
[CUSTOMER][NEUTRAL] Uh, [PII]'s date of birth is [PII]. This is the newborn baby account.
[AGENT][NEUTRAL] Hm, I don't see that the infant was listed on this policy.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] So it shows that the patient on this is a [PII]. Date of birth [PII]. It's only for that insured. I don't see any other dependents listed.
[CUSTOMER][NEUTRAL] Mm, I have the mother's details. Can you please verify with that? Yeah, it's [PII]. You got it.
[AGENT][NEUTRAL] What is the data service that?
[CUSTOMER][NEUTRAL] So for this one,
[CUSTOMER][NEUTRAL] Uh, OK. For the mother?
[AGENT][NEUTRAL] Mhm. Yeah, I can check.
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] And what's the data service that you need me to check?
[CUSTOMER][NEUTRAL] [PII]. Let me check it if there is a date range or not.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 24, but the amount is $4,244 even.
[AGENT][NEUTRAL] And you said [PII] or [PII]?
[CUSTOMER][NEUTRAL] 1st [PII].
[AGENT][NEGATIVE] I'm not showing anything on file for that bill.
[CUSTOMER][NEUTRAL] So for this one is claim is not on file?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Patient is active on the state of service?
[AGENT][NEUTRAL] Effective date is [PII].
[CUSTOMER][NEUTRAL] Just a 2nd, [PII].
[CUSTOMER][NEUTRAL] Give me a moment.
[CUSTOMER][NEUTRAL] 112422.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Alright thank you still up too.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] No, the patient planned.
[CUSTOMER][NEUTRAL] Uh, same mailing address for this one?
[AGENT][NEUTRAL] Yes, same mailing address.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Patient plan is inactive?
[AGENT][NEGATIVE] Correct. It terminated on February, no, no, no, it just terminated [PII]. It's not any longer active.
[CUSTOMER][NEUTRAL] For this data?
[CUSTOMER][NEUTRAL] But for this data of service, it is active, right?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] All right. Uh, for this 1, 608801, same, uh, payer ID, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] So, no time is falling. Everything is save for this one.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] OK
[CUSTOMER][POSITIVE] All right. Uh, well, [PII], I'm done with this. Thanks for assisting me. Have a lovely day. Bye for now.
[AGENT][NEUTRAL] You as well. Bye-bye.