AccountId: 011433970860
ContactId: f67a9389-c390-4e0b-8740-33c1cb9d70a2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 561760 ms
Total Talk Time (AGENT): 205662 ms
Total Talk Time (CUSTOMER): 138094 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/f67a9389-c390-4e0b-8740-33c1cb9d70a2_20250326T20:46_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] Yeah, hi, [PII]. This is [PII]. I'm calling from provider's office, uh, to verify the claims changes.
[AGENT][POSITIVE] OK. Well, I can definitely help you with the claim status, [PII]. May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, my callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Can you hear me now?
[AGENT][NEUTRAL] Yes, I can hear you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, just, I have one plan.
[AGENT][NEUTRAL] OK, may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Member policy number is 0 as in Oscar 167.
[CUSTOMER][NEUTRAL] 291
[CUSTOMER][NEUTRAL] 2, M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah. My first name is [PII]. Last name is [PII], and date of birth is [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 the claim you like me to look at?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] Total charge, just a 2nd. $44,0007 even.
[AGENT][NEUTRAL] OK, so the policy number that you provided termed on [PII]?
[AGENT][NEUTRAL] Policy number 1852046 became active on [PII] and turned on [PII]. So I'm gonna look at that policy and see if there's a claim on file.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] But I have the correspondence for this uh patient for primary we needed so we sent the primary with previously. Could you please verify?
[AGENT][NEUTRAL] What I'm saying is that the policy number that you gave me is no longer active, so I'm getting ready to go into the active one and search for the claim for you.
[CUSTOMER][NEUTRAL] Could you please uh repeat that uh policy number?
[AGENT][NEUTRAL] The active, the last active policy?
[CUSTOMER][NEUTRAL] No, no, no. Uh, could you repeat the policy number, uh, what I gave?
[AGENT][NEUTRAL] So the policy number that you provided was 1672912?
[AGENT][NEUTRAL] That policy is no longer active as
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The policy is no longer active as of [PII]. There's a policy that became active in [PII] and termed last month. So it was active on your date of service. I'm going to check that policy for your claim.
[CUSTOMER][NEUTRAL] Yeah, OK. Go ahead.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And you said the total was $44,0007?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold, [PII], while I look through these claims?
[CUSTOMER][NEUTRAL] Yeah, go ahead.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, 35, that's the policy number 3563.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. Um, so there's no claim on file with us for your date of service and your total bills. What's the name of the provider on the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hsia, Florida Northwest Hospital.
[AGENT][NEUTRAL] Yeah, so did you all submit it to primary and secondary because secondary has not received it. We've received 3 claims, but they're different totally different provider.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, we send the claim through paper via mail address. Just a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please verify the mailing mail address, uh, the mail address is [PII]. Is that correct mail address?
[AGENT][NEUTRAL] No, the [PII] address is no, is not the correct claims mailing address. I can give you the correct one and we also have a fax number and a payer ID if you like as well.
[CUSTOMER][NEUTRAL] Yeah. May I have those 3?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mail address and payer ID fax number.
[AGENT][NEUTRAL] that claim's mailing address?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] [PII]. Yeah.
[CUSTOMER][NEUTRAL] And be ready?
[AGENT][NEUTRAL] Um, the, the payer ID is 60801.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the fax number is 877.
[CUSTOMER][NEUTRAL] Pa.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's gonna be attention.
[CUSTOMER][NEUTRAL] 9423
[AGENT][NEUTRAL] And that's going to be attention APL claims department.
[CUSTOMER][NEUTRAL] Yeah, got it. And may I know the effect on term date for the patient plan? How could you please repeat that?
[CUSTOMER][NEUTRAL] January, what did you say?
[AGENT][NEUTRAL] Sure, hold on one moment.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, the, uh, it was active from [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And may I know the
[CUSTOMER][NEUTRAL] To amplifying limit.
[AGENT][NEUTRAL] There's no timely filing as long as the policy was active on the data service, you can file at any time.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, OK. And plant type?
[AGENT][NEUTRAL] This is the Medin supplemental gap insurance.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And group name and group number?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The group name is 18766.
[CUSTOMER][NEUTRAL] Name is 18766.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The group name is Personal Care Pediatrics.
[CUSTOMER][NEUTRAL] Name is personal care, yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, and [PII], was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Mm, no, uh-huh
[CUSTOMER][NEUTRAL] I got all the information uh.
[AGENT][POSITIVE] Alrighty, well, thank you so much for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, I have
[CUSTOMER][NEUTRAL] I have a call reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date. The first initial of my last name is [PII].
[CUSTOMER][POSITIVE] Yeah. Thank you, [PII]. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're very welcome. Thanks for calling APL bye bye.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes.