AccountId: 011433970860
ContactId: 091e69ee-5b70-4439-98b9-04c6b27ed0d0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 786869 ms
Total Talk Time (AGENT): 281448 ms
Total Talk Time (CUSTOMER): 152622 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/091e69ee-5b70-4439-98b9-04c6b27ed0d0_20250312T13:45_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the order office. May I know the client status?
[AGENT][NEUTRAL] Sure, I can help you with the claim status, and did you say your name was [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][POSITIVE] Yeah, yes, a good joke.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] My contact number one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, policy number 0241.
[CUSTOMER][NEUTRAL] 34
[CUSTOMER][NEUTRAL] 70 ML 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and the date of [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 check on?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The bill amount 2000.
[AGENT][NEUTRAL] And the total
[CUSTOMER][NEUTRAL] $2180 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] $2,103 in total. That's the only total?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Is that the only total that this bill has?
[CUSTOMER][NEUTRAL] $2180.
[AGENT][NEUTRAL] Are you saying 2180, like 80?
[CUSTOMER][NEUTRAL] Yes, yes. 180, yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so I'm showing received the claim on [PII].
[AGENT][NEUTRAL] The claim number is
[CUSTOMER][NEUTRAL] January 3rd 1 2nd.
[CUSTOMER][NEUTRAL] Yeah, process done.
[AGENT][NEUTRAL] Um, process on [PII].
[CUSTOMER][NEUTRAL] OK, and the claim number.
[AGENT][NEUTRAL] The claim number is 35.
[AGENT][NEUTRAL] The claim number, OK, go ahead. I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, tell me.
[CUSTOMER][POSITIVE] Yes, yes, yes, yes.
[AGENT][NEUTRAL] The claim number is 354.
[AGENT][NEUTRAL] 8358
[AGENT][NEGATIVE] And it was denied because the outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could I say you be?
[AGENT][NEUTRAL] OK, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Yeah, my fax number is [PII].
[CUSTOMER][NEUTRAL] [PII] 2.
[AGENT][NEUTRAL] And should I put attention, [PII]?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm asking.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] Alright, so I'll go ahead and fax this over to you now. And [PII], was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] I have 2 more clients there.
[AGENT][NEUTRAL] Is it the same number?
[CUSTOMER][NEUTRAL] No, no, different number.
[AGENT][NEUTRAL] OK, and what's the next member's policy number?
[CUSTOMER][NEUTRAL] And I call this number?
[AGENT][NEUTRAL] The call reference number for the entire call will be my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Earlier that way.
[CUSTOMER][NEUTRAL] OK, just one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Your policy number 133.
[CUSTOMER][NEUTRAL] 0836 ML8 same number on same policy.
[AGENT][NEUTRAL] I'm sorry, 1330836?
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] M L 8.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, [PII] date of birth [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And again, just for the call, 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 for [PII]?
[CUSTOMER][NEUTRAL] 926 224.
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] Total bill amount.
[CUSTOMER][NEUTRAL] 3,252.75 cents.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm showing received the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim number is 352.
[AGENT][NEUTRAL] 228 5.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And on [PII], the claim was denied because the outpatient max for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK, I will be.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the next member, is it the same member or it's a different member as well?
[CUSTOMER][NEUTRAL] Yes, different number only once.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, policy number 02.
[AGENT][NEUTRAL] Hold on one moment. Hold on one moment.
[CUSTOMER][NEUTRAL] 54, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's the same fax number um that I'm sending all the explanation of benefits to, correct?
[CUSTOMER][NEUTRAL] OK, OK, OK.
[AGENT][NEUTRAL] I'm asking.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and the next member's policy number?
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 549-460
[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] Yeah, [PII] [PII].
[AGENT][NEUTRAL] Thank you. And may I have the date of service and the total bill?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And try to build $1260 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEGATIVE] There's no, no change on it. There's no sense.
[CUSTOMER][NEUTRAL] There is not a
[AGENT][NEUTRAL] So it's $1260. There's no
[AGENT][NEUTRAL] Change at the end?
[CUSTOMER][NEUTRAL] $1260 only.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And what's the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Saint Joseph Mercy Hospital.
[AGENT][NEUTRAL] Alright, so I have a claim on file. It is the same data service. It is the same provider. It's 1000.
[AGENT][NEUTRAL] $26.90. I don't have $1260. So if that's the total bills, then there's no claim on file. Actually, hold on one moment, let me just double check because I think this is the claim.
[CUSTOMER][NEUTRAL] OK man.
[AGENT][NEUTRAL] Alright, so the total bill on this was $1260. We were billed $1,026.90. So this is the claim. Hold on one moment.
[AGENT][NEUTRAL] So the claim was received on [PII]?
[CUSTOMER][NEUTRAL] Prepare [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that claim number is 35601.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Just 1 2nd.
[CUSTOMER][NEUTRAL] Yeah, tell me claim number.
[AGENT][NEUTRAL] 3560113
[AGENT][NEUTRAL] And it was also processed on [PII]. We paid out on the claim.
[AGENT][NEUTRAL] A total of $1,026.90 to the provider.
[CUSTOMER][NEUTRAL] Pay the check only.
[AGENT][NEUTRAL] Um, it was a single check. Let me get the information for you. Hold on one second.
[AGENT][NEUTRAL] The check was issued on [PII].
[AGENT][NEUTRAL] Check number 2
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Check number?
[AGENT][NEUTRAL] Check number is 2,029,600.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And it was a single check in the amount of $1,026.90 and it is still outstanding.
[AGENT][NEUTRAL] If the check has not been received by [PII], um, you can give us a call back and we can check on the check and reissue it if we need to.
[CUSTOMER][NEUTRAL] OK, on March.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Strictly date
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Check clear date.
[AGENT][NEGATIVE] The check has not cleared. It's outstanding, which is why I'm saying if you haven't received it by [PII].
[AGENT][NEUTRAL] You can give us a call and we'll be able to check on the check and reissue it if needed, but it has to be 30 days from the day it was issued.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, could I say will be
[AGENT][NEUTRAL] Sure, I'll be faxing this EOB as well to you to the same fax number. Is that correct?
[CUSTOMER][NEUTRAL] Yes, yes, same.
[AGENT][NEUTRAL] Alrighty, well, was there anything else I can assist you with today, [PII]?
[CUSTOMER][NEGATIVE] No, no, no.
[AGENT][POSITIVE] All right. Well, thank you so much for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] Could
[CUSTOMER][NEUTRAL] OK, bye bye bye.