AccountId: 011433970860
ContactId: ef5918d7-cb92-417c-a903-f006dc757f25
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 987369 ms
Total Talk Time (AGENT): 240746 ms
Total Talk Time (CUSTOMER): 199853 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/ef5918d7-cb92-417c-a903-f006dc757f25_20250410T19:11_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi. This is [PII] calling from provider's office regarding the question on the claim. Could you help me with that?
[AGENT][NEUTRAL] What would you like help with today?
[CUSTOMER][NEUTRAL] Uh, for claims.
[AGENT][NEUTRAL] Claims, OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, [PII], I can help you with that. Do you have the policy number on you?
[CUSTOMER][NEUTRAL] Yeah, uh,
[CUSTOMER][NEUTRAL] Yes, I have, uh, uh, could you spell your name?
[AGENT][NEUTRAL] Spell my name.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Yes, my name is [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Thank you, [PII]. How are you doing today?
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] I'm good. How are you doing?
[CUSTOMER][POSITIVE] Yeah, I'm doing great. Uh, the policy ID is 01749349.
[AGENT][POSITIVE] OK, perfect, thank you.
[AGENT][NEUTRAL] OK. And then first and last name of patient and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, definitely. The patient's name is uh [PII], like uh uh the date of birth is [PII].
[AGENT][NEUTRAL] OK. And then what's the last name again?
[CUSTOMER][NEUTRAL] Yeah, it's, uh the last name is [PII]
[AGENT][POSITIVE] OK, perfect. Thank you.
[AGENT][NEUTRAL] OK, and you're checking claim status today?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then do you have a date of service and a charge amount on you?
[CUSTOMER][NEUTRAL] Yes, I have uh
[CUSTOMER][NEUTRAL] Yes, yes, yes. Uh, the date of service is [PII] and the bill amount is $430 even.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, give me just one moment.
[CUSTOMER][NEUTRAL] Sorry, what did you say? Could you repeat once more?
[AGENT][NEUTRAL] Yes, just one moment and I'll look up that claim for you, OK?
[CUSTOMER][POSITIVE] Yeah, sure, take your own time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so there is no date of service. There's no sorry, there's no claim on file for the date of service [PII].
[CUSTOMER][NEUTRAL] OK. Uh, may I know, uh, what is your, uh, mailing address?
[AGENT][NEUTRAL] Yes, our mailing address is.
[AGENT][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. What is the city name?
[AGENT][NEUTRAL] [PII] City.
[CUSTOMER][NEUTRAL] The state also [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, sir. Mhm.
[CUSTOMER][NEUTRAL] OK. What is the ZIP code?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Uh, could you spell once more for me like [PII], OK.
[AGENT][NEUTRAL] Yes, it's, so the state would just be OK, but I can spell out [PII]. It's OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] L
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] A
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Thank you so much for that. And may I know what is the timely filing limit to submit the claims?
[AGENT][NEUTRAL] There is no filing limit.
[CUSTOMER][NEUTRAL] OK. Uh-huh.
[CUSTOMER][NEUTRAL] May I know what is the uh effective date and term date of the policy?
[AGENT][NEUTRAL] Sorry, what did you say?
[CUSTOMER][NEUTRAL] Uh, may I know what is the policy effective date and term days for this patient?
[AGENT][NEUTRAL] So it looks like the policy is active.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEGATIVE] Oh sorry, the policy is actually no longer active.
[AGENT][NEUTRAL] Yes, and it looks like the policy term.
[AGENT][NEUTRAL] On just one moment.
[AGENT][NEUTRAL] It turned on 701-2023.
[CUSTOMER][NEUTRAL] 7012 but we got a payment on uh [PII].
[CUSTOMER][NEUTRAL] On the date of service, uh, [PII], we got the payment from the insurance.
[AGENT][NEUTRAL] Hold on, just one moment. Let me see if they have another policy then, because under this policy,
[AGENT][NEUTRAL] They are no longer active. Do you have a different policy number?
[CUSTOMER][NEUTRAL] No, the same policy number like uh uh 01749349.
[AGENT][NEUTRAL] OK, that's
[AGENT][NEUTRAL] That's odd. Just give me one minute.
[AGENT][NEUTRAL] I'll try to look into this really quick.
[AGENT][NEUTRAL] You said that there was a claim paid in [PII]?
[CUSTOMER][NEUTRAL] No, no, in uh [PII], uh, on the, uh, [PII], data service. [PII].
[AGENT][NEUTRAL] OK, so the date of service we do not for that date of service.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You said that one was paid. Let me see if I can pull that one up.
[CUSTOMER][NEUTRAL] Yeah, I have the claim number. Can I see that one?
[AGENT][POSITIVE] Yes sir, you can go ahead.
[CUSTOMER][NEUTRAL] Yeah, um, [PII], the claim number is 3485781.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, are you there? Hello, hey.
[AGENT][NEUTRAL] Hi, I'm still here. Yes. Mhm.
[CUSTOMER][NEUTRAL] OK. Yeah, you can check once. And also, uh, this is the data service of [PII], you said that no claim on file, but uh there is uh one more claim that is uh [PII]. We got uh denied. We got the denial for that one. I have a claim number that I have.
[AGENT][NEUTRAL] OK, what's that claim number? And I can tell you the reason why.
[CUSTOMER][NEUTRAL] OK, that would be 3558913.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so for claim number 3558913, the data service 120924, it says that these services were rendered after coverage was terminated is why it was denied.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm mhm.
[CUSTOMER][NEUTRAL] Oh, what is the policy effective date and term dated here for this one?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Sorry, give me a moment. I'm trying to find it.
[CUSTOMER][POSITIVE] Yeah, sure, take it on time.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Is this the medical, medical claims department?
[AGENT][NEUTRAL] OK. Yes, sir.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] I'm here.
[CUSTOMER][NEUTRAL] Uh, this is a medical claims department, right?
[AGENT][NEUTRAL] This is APL care team.
[CUSTOMER][NEUTRAL] So, so, could you transfer the call to medical claims department, provide the claims department?
[AGENT][NEUTRAL] Yes, just one moment, OK?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK [PII], so you're in the correct spot. You gave me 3 claim numbers.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So for the 3558913, that one was denied.
[CUSTOMER][NEUTRAL] The nightfall.
[AGENT][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] 4321
[AGENT][NEGATIVE] That one was denied because
[AGENT][NEUTRAL] See
[AGENT][NEGATIVE] That one was denied because these services were rendered after coverage was terminated.
[CUSTOMER][NEUTRAL] OK. Could you provide the coverage dates?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] So this service date was [PII].
[CUSTOMER][NEUTRAL] Uh, could you repeat the call reference number for this one?
[AGENT][NEUTRAL] Sorry, what would you like for this one?
[CUSTOMER][NEUTRAL] Could you
[CUSTOMER][NEUTRAL] Could you provide the call reference number?
[AGENT][NEUTRAL] Yes, the call reference number is my first name, which is [PII].
[CUSTOMER][NEUTRAL] The.
[AGENT][NEUTRAL] H A
[AGENT][NEUTRAL] [PII] Y
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then my last initial, which is [PII]
[AGENT][NEUTRAL] And then it would be today's date.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Mm.