AccountId: 011433970860
ContactId: 113f85e9-8d6a-451f-9dfd-9c4cc498b022
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 510320 ms
Total Talk Time (AGENT): 164579 ms
Total Talk Time (CUSTOMER): 140766 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/113f85e9-8d6a-451f-9dfd-9c4cc498b022_20250411T16:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm checking on the medical bill or dental status of the claim.
[AGENT][NEUTRAL] OK, we're just needing clarification on the claim.
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] You said we were checking on a claim?
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK, alright, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]. It's a direct line, no extension.
[AGENT][NEUTRAL] Thank you. And then, uh, did you have that policy number?
[CUSTOMER][NEUTRAL] Mhm. 0245009, Mike Lima 8.
[AGENT][NEUTRAL] OK, um, I think we're missing a digit there area. I have 0245009. Was there any other, were there any of the numbers before the MLA?
[CUSTOMER][NEUTRAL] Uh, 0245009. No, only those are the numbers there.
[AGENT][NEUTRAL] Yeah, that's not going to be lost. Uh, we're looks like we're missing a number there. Um, do you have the claim number?
[CUSTOMER][NEUTRAL] Uh yes, 354-841-6.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] S
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then uh if you would, can you verify the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. Uh, so that policy number right after the [PII], there should be an 8 before the M.
[AGENT][NEUTRAL] Just so that you are aware.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][POSITIVE] Thank you so much for that information.
[AGENT][NEUTRAL] Of course. OK, so for this claim area, uh, we are missing a copy of the primary EOB.
[CUSTOMER][NEUTRAL] Uh, yes, I think so. The primary UB was sent recently.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] OK, no, so we have not received that yet. um, how was that sent to us?
[CUSTOMER][NEUTRAL] Oh yes, just give me one quick moment. I'm checking on that here.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Just 123.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It was sent to
[CUSTOMER][NEUTRAL] PayPal
[CUSTOMER][NEUTRAL] On PO box?
[CUSTOMER][NEUTRAL] 248,950, [PII].
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] OK, yeah, so it was mailed to us then, um, it's most likely not gotten to us just yet Aia I would say generally to allow a couple of weeks, uh, for anything in the mail.
[CUSTOMER][NEUTRAL] Oh, OK, understood.
[AGENT][NEUTRAL] Now I do have a fax number um.
[CUSTOMER][NEUTRAL] Can you please provide me the call?
[AGENT][NEUTRAL] Did you want our fax number are you?
[CUSTOMER][NEUTRAL] No, that's OK.
[AGENT][NEUTRAL] OK, uh, reference number would just be my first name, last initial, and today's date. Uh so my name is spelled [PII] And was there anything else I could help you with?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] No, that's all. Thank you. Have a good day and bye for now.
[AGENT][POSITIVE] Of course, yeah, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Uh, can you hear me?
[AGENT][NEUTRAL] Oh, sure.
[CUSTOMER][NEUTRAL] Uh, I'm so sorry. How many claims can you assist me per call?
[AGENT][NEUTRAL] What was that?
[CUSTOMER][NEUTRAL] Uh, I do have 2 more members. Can you please help me with that as well?
[AGENT][NEUTRAL] Um, different, different members.
[CUSTOMER][POSITIVE] Oh, yes, yes, you got me.
[AGENT][POSITIVE] Sure, yeah, give me just a moment um I'll let you know when I'm ready for those.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Yes, yes. Thank you.
[AGENT][NEUTRAL] OK. Um, whenever you're ready, A, you can go ahead and give me that next policy number.
[CUSTOMER][NEUTRAL] 02486591 M. 7.
[AGENT][NEUTRAL] OK and then uh what was the name and date of birth for this number?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. Did you have that claim number as well or the date of service?
[CUSTOMER][NEUTRAL] The claim number 356.
[CUSTOMER][NEUTRAL] 18883 consecutive 8 at the end.
[AGENT][NEUTRAL] Got it.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Alright, so this one is also stating that we are needing the primary EOB uh and like the other we have not yet received any other information.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She remember the next patient.
[AGENT][NEUTRAL] Uh, one moment please. I'll let you know when I'm ready.
[CUSTOMER][POSITIVE] Yeah, OK, sure. Thank you.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, you can go ahead with that next policy number.
[CUSTOMER][NEUTRAL] Mhm. 02123318.
[AGENT][NEUTRAL] OK, and then the name and date of birth for this number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that and then uh did you have this claim number as well?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 3567853
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEGATIVE] OK, so this one, we were unable to pay a benefit as their outpatient benefit for the calendar year had been met.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] How much is normally allowed for the patient per year?
[AGENT][NEUTRAL] Let me check that. One moment.
[AGENT][NEUTRAL] So their outpatient benefit is $1000 max per calendar year.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Then that's all for today. I don't have any other claims. Thank you for assisting me.
[AGENT][POSITIVE] OK, of course, yeah, thanks for giving us a call. I hope you have a great weekend.
[CUSTOMER][NEUTRAL] You as well. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Mm.