AccountId: 011433970860
ContactId: fdd39105-2ec2-4f97-9ff7-f0fdcc4d0b39
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 557440 ms
Total Talk Time (AGENT): 198030 ms
Total Talk Time (CUSTOMER): 188186 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/fdd39105-2ec2-4f97-9ff7-f0fdcc4d0b39_20250203T20:08_UTC.wav
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[AGENT][NEUTRAL] For contacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling to check on a claim.
[CUSTOMER][NEUTRAL] That's what I mean.
[AGENT][NEUTRAL] Yes, I can help with the claim status. What is the um policy number, please?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 018963
[CUSTOMER][NEUTRAL] 56 M. like Mike L. Lima 8.
[AGENT][NEUTRAL] Thank you, and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Just, uh, it's one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] The number is [PII] and then there's uh initial [PII]. Last name [PII], date of birth, [PII].
[AGENT][NEUTRAL] Thank you. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you. It looks like uh we do have that um claim. We do have a, a policy for them. What is the date of service that we're we're looking at for [PII]?
[CUSTOMER][NEUTRAL] 916 24 for $11,566 even.
[AGENT][NEUTRAL] 9:16. OK. Excuse me, excuse me just a moment, please.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, so I do have [PII]. Um, he had a policy with us from [PII] until [PII].
[AGENT][NEUTRAL] Uh, but I'm not seeing a claim for [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Let me see if he doesn't have another, I just don't, um, yeah, I just don't see that he had another policy with us. So it looks like his policy with us lapsed on [PII]. Um, I don't have your claim, but I can tell you where to send it in.
[CUSTOMER][NEUTRAL] One.
[CUSTOMER][NEUTRAL] Uh, is that, uh, during the rate of service, the policy was inactive?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Alright, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, could you please again help me with the effective date?
[AGENT][NEUTRAL] Yes, the policy went into effect on [PII].
[AGENT][NEUTRAL] And it lapsed on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And do you find any other insurance for this number?
[AGENT][NEUTRAL] No, I checked and, and we don't have any other policy for [PII].
[CUSTOMER][NEUTRAL] All right. Thank you. And uh as you stated under the same member ID it shows inactive?
[AGENT][POSITIVE] It does show inactive. That's correct.
[CUSTOMER][POSITIVE] All right. Thank you so much for this information. And for this account reference, can I use your name in today's date?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII], and we're gonna use that today's date as our reference.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] All right, and may I know how many claims can I assist you with the call?
[AGENT][NEUTRAL] I can do one more. What did you have another policy number?
[CUSTOMER][NEUTRAL] Yes, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for holding. The next policy ID will be 02506178.
[AGENT][NEUTRAL] OK, 02506178.
[AGENT][NEUTRAL] And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Mhm. Yes.
[CUSTOMER][NEUTRAL] It's, I spell the first name, it's [PII]. Last name [PII], and the patient's date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And what date of service are we looking for for [PII]?
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] This isn't a facility bill, is it? Is it, is it for services?
[CUSTOMER][NEUTRAL] Uh yes, uh, it's for $579 even and I could see it's billed as secondary to you. Could you please check on that?
[AGENT][NEUTRAL] OK yes
[AGENT][NEUTRAL] OK, so 102. All right.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So I don't have this um.
[AGENT][NEUTRAL] On file, I, I do have a facility bill, uh, but I don't have the what you're looking for. So I can give you our fax number and you can fax it in. Now, there is no timely filing, uh, and it looks like his policy is active. Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That you
[CUSTOMER][NEUTRAL] Is it you have a UB04 claim in your end?
[AGENT][NEUTRAL] I, I do not have the claim. No, I'm sorry.
[CUSTOMER][NEUTRAL] All right. And on this policy, could you please help me with the uh policy of can term it?
[AGENT][NEUTRAL] Well, there's no term date. It went into effect on [PII], and it's still active.
[CUSTOMER][POSITIVE] Thank you so much. And uh could you please help me with the member uh group number and the group name?
[AGENT][NEUTRAL] Yes, the group number for this.
[AGENT][NEUTRAL] It's 265.
[AGENT][NEUTRAL] 36
[AGENT][NEUTRAL] And the group name is Grand Strand Nissan.
[AGENT][NEUTRAL] The Grand strad Nissan like the car.
[CUSTOMER][NEUTRAL] Could you please spell out?
[AGENT][NEUTRAL] Yes, it's G R A N D.
[AGENT][NEUTRAL] Strand is S T R A N D.
[AGENT][NEUTRAL] And the Nissan
[AGENT][NEUTRAL] It's N I
[AGENT][NEUTRAL] S S A N.
[CUSTOMER][POSITIVE] So much. And just give me one quick moment.
[CUSTOMER][NEUTRAL] I could see that was built through paper and for verification, could you please uh help me with your mailing address, the right mailing address?
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's in [PII].
[AGENT][NEUTRAL] And the zip code
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Do you have a fax number for claims?
[AGENT][NEUTRAL] I do. It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And do you have a payer ID?
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] Thank you so much. And may I know what method do you prefer?
[AGENT][NEUTRAL] Uh, but you can send it any way you want to. That's, it's, it's fine. It usually takes about 22 to 3 business days for that to be processed. So however you'd like to send it to us would be fine.
[CUSTOMER][NEUTRAL] All right, uh, could you please again help me with the timely filing limit?
[AGENT][POSITIVE] There there is no timely filing, it's worth the secondary insurance.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] All right, thank you so much. And could you please help me with the mobile plan type?
[AGENT][NEUTRAL] This is a secondary or gap insurance.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you so much. And that's it for this member and for reference, can I use your name in today's date?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Uh, yes, my name is [PII]. The first letter of my last name is [PII], and we're gonna use that today's date.
[CUSTOMER][POSITIVE] Thank you. Thank you so much for your assistance. Have a great day. Bye-bye.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thanks for contacting APO
[CUSTOMER][NEUTRAL] Yeah