AccountId: 011433970860
ContactId: db5e2421-28d7-4dcf-b4da-50cd51b6195e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 403980 ms
Total Talk Time (AGENT): 102524 ms
Total Talk Time (CUSTOMER): 163054 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/23/db5e2421-28d7-4dcf-b4da-50cd51b6195e_20250623T16:38_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. This is [PII] calling from provider's office and I'm checking on a claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status. And what was your name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK. And then the policy number for the patient?
[CUSTOMER][NEUTRAL] Uh, policy number starts with 02249208 Mike Lima 8.
[AGENT][NEUTRAL] Patient name and date of birth.
[CUSTOMER][NEUTRAL] Patient's first name is [PII] and the last name is [PII]. Date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Date of service and bill charges.
[CUSTOMER][NEUTRAL] D of services for [PII] for the billed amount of $332 even.
[AGENT][NEUTRAL] No, it's [PII].
[CUSTOMER][NEUTRAL] Yes, 042420254332 even.
[AGENT][NEUTRAL] I don't show that claim on file. Can you resubmit?
[CUSTOMER][NEUTRAL] Uh, yeah, we have already submitted this and it was through mail. And they had sent this may um claim to [PII] ZIP code is [PII].
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Was it correct?
[AGENT][NEUTRAL] Oh, that's not the correct address. The correct address is [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And do you have any payer electronic or uh fax so that we can submit through electronically?
[AGENT][NEUTRAL] Uh, it is electronic payer ID 60801.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And can you help me with the policy effective and termination date for this patient, [PII]?
[AGENT][NEUTRAL] Yes, um, oh, do you have a good callback number?
[CUSTOMER][NEUTRAL] Sure. The callback number would be [PII], a direct line.
[AGENT][NEUTRAL] OK. Policy effective date is [PII]. Policy is active, no term date.
[CUSTOMER][POSITIVE] Sure, thank you.
[CUSTOMER][NEUTRAL] And what would be timely finding limit to submit this claim, uh, [PII]?
[AGENT][NEGATIVE] There's no timely filing limits.
[CUSTOMER][POSITIVE] No problem. Thank you.
[CUSTOMER][NEUTRAL] Yeah. Uh, that's it for this patient. And can I go ahead with one more patient?
[AGENT][NEUTRAL] OK, and your policy number?
[CUSTOMER][NEUTRAL] Sure, thank you. The policy number starts with 01616952 M. Mike Lima 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patients first name is [PII] and the last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Date of service and bill charges.
[CUSTOMER][NEUTRAL] Uh, date of service is [PII] for the bill amount of $974 even.
[AGENT][NEUTRAL] OK, uh, looks like the policy number you gave me termed in 2024, but there's a current policy. Let me pull that up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and you say 225 25, is that right?
[AGENT][NEUTRAL] The bill charges, is the bill charges?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 974 even.
[AGENT][NEUTRAL] Well, it looks like the claim was received 3-10-2025. Process 313-2025.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Uh, service is not covered under the policy.
[CUSTOMER][NEUTRAL] Services are not covered under the policy.
[CUSTOMER][NEUTRAL] And can you let me know what type of policy it is?
[AGENT][NEUTRAL] It's a secondary policy.
[AGENT][NEUTRAL] Supplemental secondary.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, uh, did we, I, I just wanted to have a clarification as we had again resubmitted this claim, uh, once the Aetna is processed. So just checking if we, as a secondary have received this claim again on.
[AGENT][NEUTRAL] Yes, I mean, we process the claim. It's not covered under their policy. They don't cover office visits or services rendered in the doctor's office.
[CUSTOMER][NEUTRAL] So no office visits are covered under the policy.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And can I have a claim number for that?
[AGENT][NEUTRAL] Claim number 357-5303.
[CUSTOMER][POSITIVE] Sure, thank you so much for that. And uh just uh for clarification, can I have a policy effective date for this patient?
[AGENT][NEUTRAL] And one.
[CUSTOMER][NEUTRAL] As you said it was done?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. And it's still active.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm. Sure, not an issue. Thank you so much for that information, [PII]. And I do not have much on this. Can I get a reference for this patient? Would you call?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh, my name is [PII], and today's date.
[CUSTOMER][POSITIVE] Sure. Thank you so much, [PII], for your help. It was great speaking to you and have a wonderful day ahead.
[AGENT][POSITIVE] Thanks for calling ATL. You as well. Bye-bye.