AccountId: 011433970860
ContactId: ffc8ba1d-249d-4389-908b-69b99bcb5212
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 335760 ms
Total Talk Time (AGENT): 121345 ms
Total Talk Time (CUSTOMER): 126448 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/ffc8ba1d-249d-4389-908b-69b99bcb5212_20250218T20:25_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling from private office checking for claim status. Can you please spell me your name, [PII]?
[AGENT][NEUTRAL] [PII] And can you spell yours?
[CUSTOMER][NEUTRAL] Um sure. It's [PII].
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] AS
[AGENT][NEUTRAL] [PII],
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII], and you're needing, how can I help you today?
[CUSTOMER][NEUTRAL] I'm checking for the claim status.
[AGENT][NEUTRAL] OK, you have one, for one patient, you're needing claim status.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah. Yes, yes, only one patient I do have.
[AGENT][NEUTRAL] Yes, [PII], I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] Um, the callback number is going to be [PII].
[AGENT][NEUTRAL] OK, let's start over with, OK, let's start over with the phone number please [PII] [PII].
[CUSTOMER][NEUTRAL] That's the direct line
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number please?
[CUSTOMER][NEUTRAL] Um, sure. The member policy number is 02265213.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] And any information [PII] that I provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, the patient's last name is going to be [PII] and the first name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] And the date of service is going to be [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, but
[CUSTOMER][NEUTRAL] Yes, and the bill amount is $3,058 even.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And I'm looking for the remaining balance $250 which is left over from the Medicare. This is a crossover claim.
[AGENT][NEUTRAL] OK, there is no claim on file for this member for date of service [PII].
[CUSTOMER][NEUTRAL] There is no claim file for that bill amount?
[AGENT][NEUTRAL] There's no claim on file for this data service.
[CUSTOMER][NEUTRAL] OK. Hold on a second. Just give me a moment.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Just give me a moment to have a look once again here. I'll just verify the mailing address. Before that mailing address, can you please verify the patient policy effective between term date? On which date to which patient is active?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This supplemental policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK, it is active from [PII] still present, right?
[AGENT][NEUTRAL] It is active. There is no termination date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now you will also need to send a copy of the primary insurance company's explanation of benefits when you submit this claim for review.
[CUSTOMER][NEUTRAL] OK, got it. And the mailing address will be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK. [PII]. Is that correct?
[AGENT][NEUTRAL] And then after that [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed received and processed the claim for this member, you should be able to go to our portal, [PII].
[AGENT][NEUTRAL] To print our explanation of benefits and have access to the claim status and our portal website is secured.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Thank you. [PII]. OK, got it. And what we, what do we do the filing for presenting a claim?
[AGENT][NEUTRAL] Yes, sir. Uh-huh.
[AGENT][NEGATIVE] There is no timely filing limit?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No TFL limit.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Please submit claim. OK.
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And what was the call reference number for this patient?
[AGENT][NEUTRAL] My name in today's date.
[CUSTOMER][NEUTRAL] Um, I see today's date, is it correct?
[AGENT][NEUTRAL] That is correct. [PII] today and today's date.
[CUSTOMER][POSITIVE] OK, thank you. Thanks for the information. [PII]. Have a good day. Bye-bye.
[AGENT][POSITIVE] Well, you, you too, [PII], and if that is all I can help you with, thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you.