AccountId: 011433970860
ContactId: fc70a6c3-714a-49bf-9678-7d7093783378
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 243800 ms
Total Talk Time (AGENT): 84090 ms
Total Talk Time (CUSTOMER): 50579 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/fc70a6c3-714a-49bf-9678-7d7093783378_20250521T21:20_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][POSITIVE] Good afternoon
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from Texas Retina Associates for client status.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status and how many claims do you have in total today, [PII]?
[CUSTOMER][NEUTRAL] One
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Policy number.
[CUSTOMER][NEUTRAL] 02506255
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [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 and the total bills for the claim?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Total bill amount $300 even.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] So I'm not showing any claims on file for [PII] for um [PII].
[CUSTOMER][NEUTRAL] So, can I have the member's policy effective date and term date?
[AGENT][NEUTRAL] Um, the policy is still active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] 1 2nd.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So for this member, um,
[CUSTOMER][NEUTRAL] I have a document control number. I have a message from the payer.
[CUSTOMER][NEUTRAL] Which states
[AGENT][NEUTRAL] You may have some
[CUSTOMER][NEGATIVE] The claim is unable to process.
[AGENT][NEUTRAL] You may have submitted it to the primary insurance, but for secondary, we don't have anything here for that day. It's clear, like not, we don't even have one claim for that data service. So you may have presented it to or billed it to primary, but it has not been billed to APL. But there is no timely filing limit, so, and the policy is active, so you can file the claim if you'd like with secondary.
[CUSTOMER][NEUTRAL] How
[CUSTOMER][NEUTRAL] It can be sent through mail or
[CUSTOMER][POSITIVE] Pro.
[AGENT][NEUTRAL] You can mail it, you can fax it, or you can send it electronically. Um, do you prefer one of the three, or I can give you all three?
[CUSTOMER][NEUTRAL] Can I have the payer ID?
[AGENT][NEUTRAL] Yes, it's 60.
[AGENT][NEUTRAL] 80
[AGENT][NEUTRAL] One.
[CUSTOMER][POSITIVE] Thank you for patiently listing. Can I get the call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].