AccountId: 011433970860
ContactId: f5b8ad7d-e595-46c9-8feb-743d50c43308
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 301079 ms
Total Talk Time (AGENT): 116303 ms
Total Talk Time (CUSTOMER): 94112 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/f5b8ad7d-e595-46c9-8feb-743d50c43308_20250214T15:04_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah. Hi, [PII]. My name is [PII]. I'm from provider office looking for claims.
[AGENT][NEUTRAL] OK, I'm so sorry. What was your first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] OK, [PII], thank you. And you're needing claim status. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you have to check status on today?
[CUSTOMER][NEUTRAL] Only one.
[AGENT][NEUTRAL] OK, and what is that member's policy number, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So member policy 2377455.
[AGENT][POSITIVE] Thank you, one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, just one moment please, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and any information, [PII] that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her?
[CUSTOMER][NEUTRAL] Date of service is [PII]. Bill amount is $872.38.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and again, you said the data service is 95-2024 for 872.38. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, yes.
[AGENT][NEUTRAL] OK, so we do not have a claim on file for her for that data service.
[AGENT][NEUTRAL] And when you
[CUSTOMER][NEUTRAL] OK. So this claim is not on file.
[AGENT][NEUTRAL] That is correct. And when you send the claim for review, [PII], you will also need to include a copy of her primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Mhm. OK. Actually, uh, uh, United Healthcare Insurance Company already processed this claim and demanding patient responsibility was billed to your insurance. So you said claim is not on file. So what is the effective date of the member?
[AGENT][NEUTRAL] The effective date is [PII].
[CUSTOMER][NEUTRAL] It's still active with no termination.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment. What is timely filing limit?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] There is no timely filing limit.
[CUSTOMER][NEUTRAL] One moment, so.
[CUSTOMER][NEUTRAL] So, uh, there is no timely filing limit. we can submit anytime, right? After.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Yeah, what is pay ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 60801, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] The reference number of this call?
[AGENT][NEUTRAL] Uh, yes, before I give you that, uh, you, once we have received the claim and it has been processed, [PII], you can check claim status for us in our portal by going to [PII].
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] And for your reference number, you will use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Any of your last name, [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so much. Have a nice day.
[AGENT][POSITIVE] You're very welcome. Yes, sir. You too. That's all I can help you with. Thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you so much