AccountId: 011433970860
ContactId: f10fa9a6-4a42-41a5-8cf6-6fb8608430d9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 670250 ms
Total Talk Time (AGENT): 167606 ms
Total Talk Time (CUSTOMER): 150845 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/f10fa9a6-4a42-41a5-8cf6-6fb8608430d9_20250425T19:50_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling from Mclo Health to check the claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII]. May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII]. It was a direct line.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] 02521727
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Uh, actually, for this patient, I do have 6 claims. On the patient, I'm having 5 claims.
[AGENT][NEUTRAL] So 11 claims?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII] owns.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Um, I can assist you with the 1st 5 and then the remainder, um, can be found on our online service center. Um, you can process the claim statuses.
[CUSTOMER][NEGATIVE] Actually, for online website, I don't have the access for that.
[AGENT][NEUTRAL] OK, um, I can just.
[CUSTOMER][NEUTRAL] So that's why I called.
[AGENT][NEUTRAL] OK, may I have the date of service for the member's claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] $179 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] And your name is [PII]?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It's Medical Plaza Family Medicine or Mcloud Physician Associate.
[AGENT][NEUTRAL] OK, so there's no claim on file for your provider or date of service for [PII].
[CUSTOMER][NEUTRAL] Actually, for this provider's name, McCloud Regional Medical Center of the PD.
[AGENT][NEUTRAL] So we have one claim on file for your date of service. It's from a different provider name and a different total bills. We do not have your claim on file. There is no timely filing limit though. Um, I'm checking to see if the policy is active on the data service and you can file at any time.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so the policy um is still, hold on.
[AGENT][NEUTRAL] The policy is still active. It's been effective since [PII], so you can still file a claim for the member.
[CUSTOMER][NEUTRAL] Can I have your payer ID?
[AGENT][NEUTRAL] Yes, it's 60801.
[CUSTOMER][NEUTRAL] With no timely filing limit, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII]. Shall we go for the next date?
[AGENT][POSITIVE] Yes, you can give me all 5 and the total bills.
[CUSTOMER][NEUTRAL] OK. The next date, [PII].
[CUSTOMER][NEUTRAL] $325.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The next 1 [PII].
[CUSTOMER][NEUTRAL] $138.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the third one, [PII].
[CUSTOMER][NEUTRAL] $122.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the 4th 1, [PII].
[CUSTOMER][NEUTRAL] $277.
[AGENT][NEUTRAL] OK, did you have 1 more for this one or it's 6 on the other one?
[CUSTOMER][NEUTRAL] Uh, no, the last one for the same patient, [PII] 10 2025.
[CUSTOMER][NEUTRAL] $294.
[AGENT][NEUTRAL] Alright, is it alright if I place you on just a brief hold while I go through these claims?
[CUSTOMER][NEUTRAL] Mhm. Sure.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][POSITIVE] Yes, I'm here right now.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So there's no claim on file for any of these dates of service or total bills.
[CUSTOMER][NEUTRAL] OK. And uh and you said your pay rate is 60801, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. Thank you so much. And uh shall we go for the next patient? For that patient, I have only 2 claims. That will be the last.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, hold on one moment, let me note this policy.
[CUSTOMER][NEUTRAL] OK. And can I have the call reference number now to close this patient account?
[AGENT][NEUTRAL] So the um the callback number or the call reference number for the entire call is going to be my name and today's date.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Sure, just a sec.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The next policy number 020, I'm sorry, 02506216.
[AGENT][NEUTRAL] That was 02506216?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for this, uh, well, both dates of service and total bill?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] $122.
[AGENT][NEUTRAL] OK, and the next date of service and total bills?
[CUSTOMER][NEUTRAL] Next date for the same patient, [PII].
[CUSTOMER][NEUTRAL] $46.
[AGENT][NEUTRAL] OK, so we've only received one claim for this patient that we've processed, but it's um neither of these dates of service or total bill. So these claims are also not on file for the patient.
[CUSTOMER][NEUTRAL] OK. Could you please help me with the member eligibility?
[AGENT][NEUTRAL] Sure, hold on one moment. The policy is active and it's been effective since [PII].
[CUSTOMER][POSITIVE] OK. [PII], thank you so much uh for that information. That's it for today.
[AGENT][POSITIVE] Um, you're very welcome and thanks for calling APL. I hope you have a great weekend.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you, bye bye.