AccountId: 011433970860
ContactId: f8640483-9f49-4a2b-ad2a-e6e2adb0304a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 477339 ms
Total Talk Time (AGENT): 184285 ms
Total Talk Time (CUSTOMER): 77290 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/f8640483-9f49-4a2b-ad2a-e6e2adb0304a_20250304T13:31_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from provider's office. I need to check on a claim status.
[AGENT][NEUTRAL] OK [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Oh, yeah.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] My callback number is [PII], and it's a direct line.
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Member's policy number is
[CUSTOMER][NEUTRAL] 25494992
[AGENT][POSITIVE] OK, thank you. Give me a couple of moments please to get the member's information pulled up.
[AGENT][NEUTRAL] And any information [PII] that I do provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Date of service is [PII] and the total bill amount is $753.83.
[AGENT][NEUTRAL] 753.83
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] Is that correct? OK, so we do not, yes ma'am, we do not have a claim on file for him for that data service.
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Now, when the, when you do file the claim with [PII], we will also need to have you send a copy of the primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we process the claim, we do have a portal in which you should be able to check our claim status by going to [PII].
[CUSTOMER][POSITIVE] OK, then thank you so much for that information and uh
[AGENT][POSITIVE] Yes ma'am, you're welcome.
[AGENT][NEUTRAL] And is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Can I have your mailing address to send the same?
[AGENT][NEUTRAL] The claim's mailing address is [PII].
[AGENT][NEUTRAL] And that is located in [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEGATIVE] Now this policy was not
[AGENT][NEUTRAL] Active for your data service this policy did not go into effect until [PII].
[CUSTOMER][NEUTRAL] Uh, can I have the members effective and the term date?
[AGENT][NEUTRAL] Effective date of [PII].
[AGENT][NEUTRAL] And there is no term date.
[CUSTOMER][NEUTRAL] So the member was not active for the date of service, right?
[AGENT][POSITIVE] Yes ma'am, that's what I said that that is correct.
[AGENT][NEUTRAL] There was, give me just a moment, so there was another policy that was active for this data service so let me see if we received and processed the claim under the correct policy number.
[AGENT][NEUTRAL] The policy number that would have been active for that data service is 181.
[AGENT][NEUTRAL] 3059.
[AGENT][NEUTRAL] It had an effective date of [PII].
[AGENT][NEUTRAL] And a term date of [PII].
[AGENT][NEUTRAL] So give me just one moment to look at that policy, please.
[CUSTOMER][NEUTRAL] And may I know what is the timely filing limit to submit a claim?
[AGENT][NEUTRAL] There is no timely filing, but [PII], give me a moment to see if the claim was received on the correct policy number. Just one moment please.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] It's gonna take me just a moment to get the other policy information pulled up.
[CUSTOMER][NEUTRAL] Oh yeah, sure.
[AGENT][NEUTRAL] And you said the data services [PII], correct?
[CUSTOMER][POSITIVE] Oh yeah, that's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so yes ma'am, there is also no claim on file for him under that 2nd policy number that I gave you that would have been active for his data service.
[AGENT][NEUTRAL] The 1813059.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] 3059. OK, then. Thank you so much for all the information. May I know your name?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Again, my name is [PII] and my name in today's date will be your call reference number.
[CUSTOMER][NEUTRAL] Can you spell out your name for me?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And your last name initial?
[AGENT][NEUTRAL] [PII] and your last name initial?
[CUSTOMER][NEUTRAL] Uh, that is [PII].
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][POSITIVE] OK, [PII], then thank you so much for all the information. May you have a great day ahead.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] I hope you do too and if that's all I can help you with, and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Uh-huh. Bye bye.