AccountId: 011433970860
ContactId: 0f655b71-1fb5-4d3a-973b-d290d2189541
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 331380 ms
Total Talk Time (AGENT): 118735 ms
Total Talk Time (CUSTOMER): 111862 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/0f655b71-1fb5-4d3a-973b-d290d2189541_20250122T20:17_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I am calling from Sound Health Services, and I need to check status on a claim. Um, I wasn't able to pull it up on the portal, but we submitted it. Um, it's been a bit and we've not received any denial or anything on it.
[AGENT][NEUTRAL] OK, [PII], so you would file a claim with APL and you're wanting to check status on it, is that correct?
[CUSTOMER][NEGATIVE] Correct, it's yeah and it's not coming up on the portal.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] Direct call back no extension is [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] Yes, policy number is going to be 01897867.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And again, any information that I do provide for you would be a verification of benefits and not a guarantee of payment. What is her um data service and total bills amount? I was about to ask you to tell me your name and uh everything again. Goodness.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] It's OK it's OK. It's [PII] $273.94.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Say the amount one more time.
[CUSTOMER][NEUTRAL] $273.94.
[AGENT][POSITIVE] 94. OK, thank you.
[CUSTOMER][NEUTRAL] And it was submitted, let's see.
[CUSTOMER][NEUTRAL] It was submitted on [PII].
[AGENT][NEUTRAL] And what is the provider facility name?
[CUSTOMER][NEUTRAL] Sound Health Services.
[AGENT][NEUTRAL] OK, so this claim was received on [PII]?
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEGATIVE] See it wouldn't come up on the portal.
[AGENT][NEUTRAL] The claim number for it is 3511391.
[AGENT][NEUTRAL] And I can't, were you able to access it with the claim number?
[CUSTOMER][NEUTRAL] No, I'm gonna try to go back and do that just one second. I was doing it by policy number, so let's see.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh sure.
[CUSTOMER][NEGATIVE] It's submitting it's just slow here.
[AGENT][POSITIVE] Oh yeah. Oh, you're fine. No worries.
[CUSTOMER][NEUTRAL] Alright, so I'm gonna try claim number now 3511.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Search
[CUSTOMER][NEUTRAL] OK, so it came up by the claim number it wouldn't come up just under her.
[CUSTOMER][NEUTRAL] Policy number see if we don't have for checking status we don't have the claim number.
[AGENT][NEUTRAL] Right, but I don't think.
[CUSTOMER][NEUTRAL] To be able to pull it up on the portal.
[AGENT][NEUTRAL] Yeah, I don't think that, uh, hold on, let me look. I don't think it asked for their policy number. I think it asked for their patient account number.
[CUSTOMER][NEUTRAL] It's oh I'm sorry, and last four digits of their social which I did put in but um.
[CUSTOMER][NEUTRAL] OK, it's saying it's downloading the EOB but it's not popped up yet.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, let's make sure just while we're still on our call so you don't have to call back, yeah.
[CUSTOMER][NEUTRAL] Yeah, before I
[CUSTOMER][NEUTRAL] OK, and there was no payment made, is there any reason?
[AGENT][NEUTRAL] That is correct. Yes, if you, the remarks are on the 2nd page of it, but the remarks for this particular claim is office visits are not covered by this policy.
[CUSTOMER][POSITIVE] Oh awesome.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the other two codes, the insured, that, you know, the primary insurance provided full benefits. So.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Alright, so office visit it's not covered, OK.
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] Alright, and is there a call reference number for our call or just your name and today's date?
[AGENT][NEUTRAL] That's it. My name in today's date.
[CUSTOMER][POSITIVE] All right thank you you have a good day.
[AGENT][POSITIVE] Well, you too, and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Mhm bye bye.
[AGENT][NEUTRAL] Bye-bye.