AccountId: 011433970860
ContactId: e2a3a611-7db5-4cae-a894-1fbe61c4d73b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 564679 ms
Total Talk Time (AGENT): 258901 ms
Total Talk Time (CUSTOMER): 155671 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/e2a3a611-7db5-4cae-a894-1fbe61c4d73b_20250513T19:44_UTC.wav
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[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm looking for medical claim status.
[AGENT][NEUTRAL] I can help with the same status [PII]. What is that policy number that we're looking at today?
[CUSTOMER][NEGATIVE] Uh, your voice is very muffled. I cannot hear your voice.
[AGENT][NEUTRAL] But can, can you hear it better now?
[CUSTOMER][NEUTRAL] Yes, uh, some background noise coming from your mic.
[AGENT][NEUTRAL] Yeah, I'm sorry, that's the same thing I'm having with yours. I apologize. Um, [PII], what is the policy number that we're looking at today?
[CUSTOMER][NEUTRAL] Yes, uh 1,572,980.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yes. First name is [PII] and last name is [PII], and date of birth is [PII].
[AGENT][POSITIVE] OK, I appreciate that. Um, if I could have a callback number, please, in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes. It's [PII].
[AGENT][NEUTRAL] OK, thank you very much. What data of service are you looking for from Mr. [PII]?
[CUSTOMER][NEUTRAL] Yes, 6 total of 2024. And the total charges $4490 even.
[AGENT][NEUTRAL] OK, thank you. Your claim number on this is 355.
[AGENT][NEUTRAL] 2282. Let me, uh, since we're having trouble with my phone, let me um let me repeat that. It's [PII].
[AGENT][NEUTRAL] 2282.
[AGENT][NEUTRAL] And it looks like we, it looks like we received your claim, um, let me just see what we have.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like we received your claim, um.
[AGENT][NEUTRAL] On the [PII].
[AGENT][NEUTRAL] And we processed it on the [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now, the policy
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] As of [PII]. So the policy was good from [PII].
[AGENT][NEGATIVE] [PII] until [PII], but at that point it lasted.
[AGENT][NEUTRAL] And so the policy was not active on that date of service.
[AGENT][NEGATIVE] So that is why it was not covered.
[CUSTOMER][NEUTRAL] OK, it's not active.
[AGENT][NEUTRAL] Right, not active by, it was denied by the patient's plan, which was not active as of that particular day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The policy end on which date? The effective date and term date? Could you repeat again?
[AGENT][NEUTRAL] Yes, it was, yes, [PII].
[AGENT][NEUTRAL] Until [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You shouldn't have any other ID insurance?
[AGENT][NEUTRAL] I, I don't show that he does. That's the only policy that I have active in our system. Um, is there anything else that I can help with?
[CUSTOMER][NEUTRAL] Uh, I have 2 more claims. It's a different patient. Are you able to assist other two claims?
[AGENT][NEUTRAL] Yes, and what, what is the next policy number?
[CUSTOMER][NEUTRAL] Yes, one moment.
[CUSTOMER][NEUTRAL] 02457037
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yes, [PII], and date of the [PII].
[AGENT][NEUTRAL] Thank you. And what date of service were you looking for for [PII]?
[CUSTOMER][NEUTRAL] Yes, uh, [PII] and the total charges $5,549 even.
[AGENT][NEUTRAL] OK, thank you very much. It looks like your claim number is 35.
[AGENT][NEUTRAL] 27
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 887.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, let me just see what happened with this. Excuse me just a moment please.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it looks like we received your claim.
[AGENT][NEUTRAL] Um, but the, uh, explanation of benefits from the major medical would never, um,
[AGENT][NEGATIVE] He's never received
[AGENT][NEUTRAL] So we are looking for an explanation of benefits.
[CUSTOMER][NEUTRAL] OK. They are the
[CUSTOMER][NEUTRAL] Uh yes, uh.
[CUSTOMER][NEUTRAL] You have the claim received and processed it.
[AGENT][NEUTRAL] Yes, it looks like it was received on the [PII] and processed on the [PII].
[CUSTOMER][NEUTRAL] OK. Uh, previously, we send the primary on.
[CUSTOMER][NEUTRAL] Uh, one moment.
[CUSTOMER][NEUTRAL] On [PII], we submit through uh corrected claim. Did you receive the corrected claim on backside we attached to Prime AB?
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] No, I, I'm sorry we haven't, um.
[AGENT][NEUTRAL] I haven't gotten another uh.
[AGENT][NEUTRAL] Claim for that date of service.
[AGENT][NEUTRAL] It looks like we're still waiting for that for that EOB so that I can give you our um, our mailing address or our fax number if you want.
[CUSTOMER][NEUTRAL] OK. Uh, may I have your fax number?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Attention to?
[AGENT][NEUTRAL] It would be attention points.
[CUSTOMER][NEUTRAL] Uh, any time limit for resubmit the primary UB?
[AGENT][NEUTRAL] Uh, no, no, that's fine. Just any time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, shall I move to last claim?
[AGENT][NEUTRAL] Yes, and what is that, uh, excuse me, what is that policy number, please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, the policy number is 02457037.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yes, [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, and what date of service do we have for him?
[CUSTOMER][NEUTRAL] Yes, [PII] and the total charges $5,803.25.
[AGENT][NEUTRAL] OK, this, this is the same thing that we had before where um the uh uh major medical EOB was received. That claim number is 349.
[AGENT][NEUTRAL] 0746
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And it looks like we received that claim.
[AGENT][NEUTRAL] On the [PII] and we process it on the [PII], but what we're looking for is it's just pending, and what we're looking for is that explanation of benefits from the major medical. So if we could get that, then we can go ahead and send these process.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yes, uh, we send this primary will be on [PII]. We submit through fax, the fax number is [PII]. Did you receive the primary OB?
[AGENT][NEUTRAL] Oh, no, no, I haven't. Um, it looks like that's the let me just check again.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] So this is for a data service, uh, [PII], is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me just look one more time.
[AGENT][NEUTRAL] No, that's the only thing that I've got.
[AGENT][NEUTRAL] Um, I don't know why I don't have it. That's the right fact.
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] OK. This time I submit to your mailing address. May I have your mailing address?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]. That is in [PII] City, [PII].
[AGENT][NEUTRAL] Our zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Uh, could you spell your name, please?
[AGENT][NEUTRAL] It's [PII] and we're going to use that today's date as a reference.
[AGENT][NEUTRAL] Is there anything else at all that I can help with?
[CUSTOMER][POSITIVE] OK. Thank you, sir.
[CUSTOMER][POSITIVE] No, that's it. Thanks for your assistance. Have a good day, [PII].
[AGENT][POSITIVE] Oh, thanks for contacting me