AccountId: 011433970860
ContactId: 0f27ac00-36d7-4624-b26d-a431080b7a73
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 388059 ms
Total Talk Time (AGENT): 139685 ms
Total Talk Time (CUSTOMER): 207519 ms
Interruptions: 5
Overall Sentiment: AGENT=1.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/0f27ac00-36d7-4624-b26d-a431080b7a73_20250514T17:50_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL.
[CUSTOMER][NEUTRAL] E
[CUSTOMER][NEUTRAL] Hey, this is [PII] from the provider's office looking for the claim status.
[AGENT][NEUTRAL] OK, I'm sorry, it's very difficult to hear you. Um, you said Ms. [PII]?
[CUSTOMER][NEUTRAL] I'm sorry. This is very difficult to hear you.
[CUSTOMER][NEUTRAL] Is it better now?
[AGENT][NEUTRAL] Much better thank you. You said your name is [PII] and we're um checking out a claim?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][POSITIVE] OK, thank you so much, and I can definitely check that for you. Um, can I first get a good call back number from you in case we're disconnected?
[CUSTOMER][POSITIVE] Thank you so much, and I can definitely check that for you. Um, can I take a callback number for the callback number will be [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] And then do you have that policy number?
[CUSTOMER][NEUTRAL] Absolutely. That is 02576313.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] What was the name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth, [PII], that's 14.
[CUSTOMER][NEUTRAL] Year is [PII].
[AGENT][NEUTRAL] Thank you for verifying that [PII]. uh, what was the date of service for this time, please?
[CUSTOMER][NEUTRAL] Find that and then what would be date of service for this time?
[CUSTOMER][NEUTRAL] [PII] for $1400 even.
[AGENT][NEUTRAL] OK, that was [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Got it thank you one moment please.
[CUSTOMER][NEUTRAL] Be one moment please.
[AGENT][NEUTRAL] OK. So we did receive this claim, [PII]. Uh, so the anesthesia benefits are based on benefits allowable under the surgical benefits. So we need these surgical charges for this date so that we can uh do both benefits. We can't do just the anesthesia without the surgery.
[CUSTOMER][NEUTRAL] So we did receive the claim here.
[CUSTOMER][NEUTRAL] Uh, the anesthesia benefits are based on benefits allowable under the surgical benefits, so we need these surgical charges for the state so that we can uh do those benefits. We can't give you the anesthesia without the surgery. Uh, I do understand that, but the date of service was of [PII]. So can you try to look if in case the surgery will or the facility bill was already received by you guys?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] I'm not showing that it has. This is just for the anesthesia.
[CUSTOMER][NEUTRAL] Um, well, it won't be us who will be sending that surgery will. It will obviously that.
[CUSTOMER][NEUTRAL] will be submitted by the facility itself.
[AGENT][NEUTRAL] Right, so the anesthesia benefit for this policy is a percentage based off of the surgical benefit that we pay. So we wouldn't know how much to pay the anesthesia until we pay the surgical benefit.
[CUSTOMER][NEUTRAL] So you're saying that you haven't received any bill yet from the facility, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Can you verify what facility you have for this member and for the day of service we are talking for?
[AGENT][NEUTRAL] I don't, all I see is from this anesthesia, so that's, uh, I believe that's Jor Anesthesia Services.
[CUSTOMER][NEUTRAL] Our anesthesia services is for professional services.
[AGENT][NEUTRAL] So I don't see anything from the provider. Yes, I don't see anything from the provider.
[CUSTOMER][NEUTRAL] OK. So, uh, again, anesthesia Service will be billing only and only professional services.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Facility bills will be submitted by Archibold Surgery Center because they are the facility, not us.
[AGENT][NEUTRAL] OK, yes, I don't have anything from them. So until they send that, we won't know how much to pay for the anesthesia.
[CUSTOMER][NEUTRAL] So, again, for to verify, do you have any bill?
[CUSTOMER][NEUTRAL] For Archieval Surgery Center.
[AGENT][NEUTRAL] I'm so sorry. Uh, could you repeat that, [PII]?
[CUSTOMER][NEUTRAL] Have you received any claim?
[CUSTOMER][NEUTRAL] From Archibald Surgery Center.
[AGENT][NEUTRAL] No, sir, we have not. We only have two claims on file for this state of service, one is for the anesthesia, one is from a completely different provider. I believe it's for lab work.
[CUSTOMER][NEUTRAL] Can you please help me with that provider's name, the other provider?
[AGENT][NEUTRAL] Uh, it's a lab core.
[CUSTOMER][NEUTRAL] So that is the name?
[AGENT][NEUTRAL] Yeah, that's the only other claim I have on file. We don't have any surgery, surgical claims on file for this member for this state of service. Until we get that, we won't be able to pay the anesthesia benefit.
[CUSTOMER][NEUTRAL] OK, just bear with me. Yeah, I, I, I do get it. I do get it. Just bear with me.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so I do understand that. So you haven't receive any surgery yet, so.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Without surgery bills, you won't be processing any of the anesthesia bills at all, right?
[AGENT][NEUTRAL] Right, cause we're unable to know how much to pay as the anesthesia benefit as a percentage based off of the surgical benefit that we pay.
[CUSTOMER][NEUTRAL] How much to pay as the anesthesia benefit.
[CUSTOMER][NEUTRAL] Got it. So can you please spell your name for my notes?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, any reference number for the call?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh so my last initial is A as in Alpha. Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] I thank you for your information. So thank you so much for the information and have a good day.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.
[CUSTOMER][POSITIVE] Of course, thanks for calling APL you too bye bye.