AccountId: 011433970860
ContactId: 13313d05-f983-432e-98cd-048729389b66
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 281390 ms
Total Talk Time (AGENT): 136846 ms
Total Talk Time (CUSTOMER): 92440 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/13313d05-f983-432e-98cd-048729389b66_20250121T20:04_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] Hello. Good afternoon, [PII]. I'm [PII], calling from American Clinic regarding a claim status.
[AGENT][NEUTRAL] OK, [PII], you're needing a claim status. Is that correct?
[CUSTOMER][NEUTRAL] Yeah. Yeah.
[AGENT][POSITIVE] Yes, I can help you with that and what is your callback number?
[CUSTOMER][NEUTRAL] Yup, sure. It is [PII].
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you, OK. How many claims do you have to check status?
[CUSTOMER][NEUTRAL] Direct line.
[CUSTOMER][NEUTRAL] Yup, I have 3 claims.
[AGENT][NEUTRAL] OK. Are they for the same patient and different dates of service? OK. So what is, what is the patient's policy number?
[CUSTOMER][NEUTRAL] Same patient, yeah.
[CUSTOMER][NEUTRAL] Yeah. Mhm.
[CUSTOMER][NEUTRAL] Yeah, it is
[CUSTOMER][NEUTRAL] 024
[CUSTOMER][NEUTRAL] 88097
[CUSTOMER][NEUTRAL] M like Mary, L like Lima, number 7.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] One moment, please.
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide for you today on any of the claims will be a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] And also if you need a copy of any of the explanation of benefits if we have the claims on file, you can get those by going to our portal at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Yes, uh it is [PII]. Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so I can tell you [PII] on this. I'll be happy to check the dates of service for you, however, we do not have any claims on file for this number.
[CUSTOMER][NEUTRAL] 00, I see. Let me see.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] It has active uh coverage, right?
[CUSTOMER][NEUTRAL] For the [PII].
[AGENT][NEUTRAL] This this supplemental policy is active and the effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. You're a supplement policy, right?
[AGENT][NEUTRAL] Is your dates of service after that? Yes, sir, we are not a major medical insurance.
[CUSTOMER][NEUTRAL] Uh-huh right.
[AGENT][NEUTRAL] This will be a supplemental policy only are your dates of service after [PII]?
[CUSTOMER][NEUTRAL] Yeah, all 3 is in November.
[AGENT][NEUTRAL] Yes, sir, and we, mhm.
[CUSTOMER][NEUTRAL] And I think it is, uh, yeah, yeah, incorrectly with the to the.
[CUSTOMER][NEUTRAL] Secondary, yes, before the primary.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And so because this is a supplemental policy, [PII], we will have to have the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] Mm mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then as I mentioned before, we do have our portal uh to get the explanation benefits for APO once we have processed our claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah. Yeah, yeah. I have access to the portalless server. All right.
[AGENT][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] And uh thank you. And uh do you have any uh information regarding the primary coverage?
[AGENT][NEUTRAL] I would only be able to provide you with who we show for his employer, but I don't have any detailed information. We show Aetna as the primary.
[CUSTOMER][NEUTRAL] Uh-huh, right, yeah, I have it covered.
[AGENT][NEUTRAL] Uh, well, let's see, um, give me, no, give me just a second to review something.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, mhm, we show Aetna as the primary.
[CUSTOMER][POSITIVE] OK, that's right. Great. I have the coverage. All right, then, yes, thank you. Thank you for the information. Can I have a reference number please sir?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] My name along with today's date.
[CUSTOMER][POSITIVE] Mhm, right. OK, great. Thank you.
[AGENT][POSITIVE] OK, you're welcome [PII]. So thank you again for calling APL if that's all I can help you with, and I hope you have a nice rest of your day.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Have a great day. Bye.
[AGENT][POSITIVE] Thanks. Bye-bye.