AccountId: 011433970860
ContactId: f075cd72-71fc-4c03-8839-d2e0750f2036
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 856659 ms
Total Talk Time (AGENT): 320685 ms
Total Talk Time (CUSTOMER): 251267 ms
Interruptions: 3
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/f075cd72-71fc-4c03-8839-d2e0750f2036_20250425T16:54_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII]. I'm calling from Pader office following claim status. Uh, could you spell your name, please?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] [PII], and can you spell yours?
[CUSTOMER][NEUTRAL] Uh, it's uh [PII].
[AGENT][NEUTRAL] I'm OK, [PII], is that correct?
[CUSTOMER][POSITIVE] Yeah, yeah, correct.
[AGENT][NEUTRAL] Thank you and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Uh, it is [PII].
[AGENT][NEUTRAL] Thank you. And how many claims do you have to check status on today, [PII]?
[CUSTOMER][NEUTRAL] Uh, I, I, I have 3 claim only.
[AGENT][NEUTRAL] How many?
[CUSTOMER][NEUTRAL] 3
[AGENT][NEUTRAL] 3, OK, for you have one data service for 3 different members, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] No, no, no. Uh, uh, there are 3 claim mode, 3 different numbers.
[AGENT][NEUTRAL] OK, so you have 3, I'm trying to understand. So you have 3 different policies.
[AGENT][NEUTRAL] And they each have 1 date of service or they each have 3 dates of service?
[CUSTOMER][POSITIVE] Yes, correct.
[CUSTOMER][NEGATIVE] No, no, no.
[CUSTOMER][NEUTRAL] Uh, each have 33 data service, uh, and 3 different ma'am.
[AGENT][NEUTRAL] OK, yes, I can help you and [PII], you would use my name that I gave you along with today's date as your call reference number for each one.
[AGENT][NEUTRAL] Also, any information that I provide for you today on any of the claims will be a verification of benefits and not a guarantee of payment. And lastly, if we do have a claims on file [PII] and you need a copy of the explanation of benefits, once you have the claim number, you can print those from our portal by going to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Alright, you're welcome. So what is your first patient's policy number?
[CUSTOMER][NEUTRAL] It is 02399312.
[AGENT][NEUTRAL] OK, thank you. One moment while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's uh [PII].
[CUSTOMER][NEUTRAL] And date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the first date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Uh, [PII] and the charges amount is uh $1,969.
[AGENT][NEUTRAL] 1959.
[CUSTOMER][NEUTRAL] No, 1969.
[AGENT][NEUTRAL] 69. OK, thank you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and you said the date of service is [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so there is no claim on file for that data service. Uh, let me check. Give me just one moment, [PII], one second, let me.
[AGENT][NEUTRAL] Let me read it, look at something.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so yes, there is actually a claim on file.
[AGENT][NEUTRAL] And one moment and I'll provide you that the claim number is 343-733-4.
[CUSTOMER][NEUTRAL] Uh, what is your number?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This claim was received on [PII] and processed the same date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this claim was denied, and the reason for the denial is that we are in need of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK, just a second. Actually, uh we.
[CUSTOMER][NEUTRAL] You already submitted the primary OB through fax on uh October.
[AGENT][NEGATIVE] So we've not received that. We
[CUSTOMER][NEUTRAL] OK. Uh, what's your first fax number?
[AGENT][NEUTRAL] [PII] attention claims department.
[CUSTOMER][NEUTRAL] OK. Uh, you said you don't receive any UB from my side. OK. Uh, could you confirm what is the timely filing?
[AGENT][POSITIVE] That is correct.
[AGENT][NEGATIVE] There's no timely filing to submit this?
[CUSTOMER][NEUTRAL] Oh, to submit a primary OB.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] No, actually, I'm asking to you, what is timely filing for submit uh prime UB.
[AGENT][NEGATIVE] Yes, uh, yes, sir, and I said there is no timely filing.
[CUSTOMER][NEUTRAL] Oh, OK. I'm sorry. No I funny.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, I'm sorry. Uh, OK. Uh, could you, uh, confirm your, your mailing address?
[AGENT][POSITIVE] That's OK. No worries.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Which is the same that should be on their ID card.
[CUSTOMER][POSITIVE] OK. Thank you so much for confirming that. Uh, I'll provide you next one. Just a second.
[AGENT][POSITIVE] No. Yeah. You're welcome.
[AGENT][POSITIVE] OK. And the next, yes, I'm ready for the next day of service when you are.
[AGENT][NEUTRAL] In total build amount
[CUSTOMER][NEUTRAL] Yes, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, next policy number is.
[AGENT][NEUTRAL] Oh, wait, you said, OK, now, you had said there were 3 dates of service for this number.
[CUSTOMER][NEUTRAL] 024
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so it's the same policy, 239-9312?
[CUSTOMER][NEUTRAL] No, it is 02450110.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] OK, so you do not have 3 dates of service for [PII].
[CUSTOMER][NEUTRAL] No, no. Actually, uh, actually, uh, actually, uh, I have 3 different numbers.
[AGENT][NEUTRAL] OK, so give me just a moment then to complete my portion of hers. One moment.
[CUSTOMER][POSITIVE] OK, take your time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I like
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Uh, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it is uh
[CUSTOMER][NEUTRAL] It is 02450110.
[AGENT][NEUTRAL] OK, thank you, [PII], one moment.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, patient name is uh [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Day the service and total bill amount, please.
[CUSTOMER][NEUTRAL] Uh, data services [PII] and the charges amount is $15,272. I'm sorry, 05 cents.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so we do not have a claim on file for [PII] for [PII]. no claim on file.
[CUSTOMER][NEUTRAL] OK. There's no claim on file. And uh could you confirm what uh mailing, what is the mailing address for submit uh this claim?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, sir, it is
[AGENT][NEUTRAL] Yes, sir. It is the same as the one that I previously went over with you.
[CUSTOMER][NEUTRAL] Uh, [PII] is correct?
[AGENT][NEUTRAL] [PII] attention claims department.
[AGENT][NEUTRAL] And we will also have to have a copy of the primary insurance company's explanation of benefits along with this claim as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. Uh.
[CUSTOMER][NEUTRAL] Uh, you said uh there is no claim on file. Uh, could you confirm me, uh, what is the timely filing for, uh, NSL claim submitted?
[AGENT][NEUTRAL] And do you need?
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][POSITIVE] OK. Thank you so much. Uh, do you have any pay ID?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] 60801.
[AGENT][NEUTRAL] But again, we will have to have a copy of the primary EOB also.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just a second. I'll probably do the last one.
[AGENT][NEUTRAL] One moment.
[AGENT][POSITIVE] OK, and I'm ready whenever you are.
[CUSTOMER][POSITIVE] Yeah, I'm ready.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh just a moment. I'll provide your member ID first.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, policy ID is 02.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yes. 02046873.
[AGENT][NEUTRAL] OK, thank you, [PII]. One moment.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII]. And date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And the charges amount is uh 1370. 0.
[AGENT][NEUTRAL] OK, give me, give me.
[AGENT][NEUTRAL] All right, give me just a moment please, there.
[CUSTOMER][NEUTRAL] Oh, sure.
[AGENT][NEUTRAL] What is the date of service again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. And total bail amount.
[CUSTOMER][NEUTRAL] Uh, it's $1,371 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and again to reverify the date of service is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, there is no claim on file for that data service.
[AGENT][NEUTRAL] Uh, this one we will also have to have the primary insurance company's explanation of benefits along with the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it would be that same uh claims PO box.
[CUSTOMER][NEUTRAL] OK. Uh.
[AGENT][NEUTRAL] Pay fax, all that's the same. Mhm.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Oh, the box is, OK.
[CUSTOMER][NEGATIVE] And there is no timely filing is correct?
[AGENT][POSITIVE] And no time is fine. That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, could you provide me a member fact date for this number?
[AGENT][NEUTRAL] The policy has an effective date of [PII] and a termination date of [PII].
[CUSTOMER][NEUTRAL] And the current is active or not?
[AGENT][NEUTRAL] No, sir. I just gave you the term date of [PII].
[CUSTOMER][NEUTRAL] OK, that was the policy uh member was not active uh.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] Yes. OK. You're very welcome.
[CUSTOMER][NEUTRAL] Uh, may I, may I have a reference uh reference number?
[AGENT][NEUTRAL] Yeah. As I explained to you initially, you would use my name along with today's date.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII]. Thank you. Have a good day.
[AGENT][POSITIVE] All right, [PII]. Well, you're welcome. Yes, sir. And if that's all I can help you with, then thank you again for calling APL. I hope you have a great weekend.
[CUSTOMER][POSITIVE] OK you too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.