AccountId: 011433970860
ContactId: 15597db0-6e46-4426-af4c-a22f1f0e76ea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 322179 ms
Total Talk Time (AGENT): 126940 ms
Total Talk Time (CUSTOMER): 168358 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/15597db0-6e46-4426-af4c-a22f1f0e76ea_20250131T16:27_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] Um.
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. This is [PII] from provider's office. I have uh one claim uh for some query. Would you please help me with that?
[AGENT][POSITIVE] Sure, I'll be more than happy to assist you with the claim clarity and [PII], may I have a good contact number in case we're disconnected and then the policy number?
[CUSTOMER][NEUTRAL] Yeah. Yes, uh [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you for that. And the number's policy number?
[CUSTOMER][NEUTRAL] Policy number is 01783671.
[AGENT][NEUTRAL] 83671. OK, thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], and the date of birth was on [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 claim number or the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The date of service was on [PII] bill amount $1,244 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 56836.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It's from
[CUSTOMER][NEUTRAL] Provider's office or it's from uh Lou yeah, Louisiana dermatology.
[AGENT][NEUTRAL] The facility name.
[AGENT][NEUTRAL] Thank you, hold on one moment while I pull up the claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I'm trying to receive the claim on [PII]?
[AGENT][NEUTRAL] The claim number
[CUSTOMER][NEUTRAL] Yes, uh, uh, so sorry to cut you off. I already got, we already have the status, but we need, uh, the EOB. So can you send us the EOB through our fax number?
[AGENT][NEUTRAL] What's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII]. Attention to Bianca.
[AGENT][NEUTRAL] And that was 972-338-40007. Attention, Bianca.
[CUSTOMER][POSITIVE] That's right. Yes, thank you.
[AGENT][NEUTRAL] Alright, so I'll go ahead and send this over. Go ahead.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, yes, like, uh, this claim, they said that they denied due to the calendar for the patient visits per calendar year. So we requested that it will be since already one month, so still we don't receive. Do you have any idea why it takes too much time to to receive the UB? Like is there any specific reason for that?
[AGENT][NEUTRAL] The explanation of benefits was mailed to you on [PII].
[CUSTOMER][NEUTRAL] Mhm mhm. Yeah, that one we got, but when we call.
[CUSTOMER][NEUTRAL] Uh, when we spoke, one of your members, so she said that, so we just request the update you be, but still we didn't receive yet.
[AGENT][NEUTRAL] Updated in what way?
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] You said you requested an updated you. OK, go ahead, you go ahead and talk.
[CUSTOMER][NEGATIVE] For the deny, yeah, yeah, for the, yeah, for that denied EUB.
[AGENT][NEUTRAL] Right, but you just said that you received it. We mailed it on [PII]. It's the same copy. Did you want me to fax you? There's no updated, OK, go ahead.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, no, no. We, uh, no, you didn't get and uh you, uh, this came, right, when we spoke last time, one of your members, he said that is denied due to the calendar. It's made for the patient visit per calendar year. So we need that EOP, right?
[AGENT][NEUTRAL] Correct, and I advised that it was sent, it was mailed to you on [PII] and you said you received it, you needed an updated explanation of benefits. So I then asked you update it, I then asked you updated in what way?
[CUSTOMER][NEUTRAL] No, no, we
[AGENT][NEGATIVE] There is no updated EOB.
[CUSTOMER][NEUTRAL] No, no, it's still with your.
[CUSTOMER][NEUTRAL] Yes, we need that one, but because we don't receive it.
[AGENT][NEUTRAL] OK, so you just need a copy of the explanation of benefits faxed to you. OK, so I'm faxing that to you now. Was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] Yes, yeah, yes, thank you.
[CUSTOMER][NEUTRAL] No, like, uh, it's, uh, how long it will take to receive?
[AGENT][POSITIVE] So with facts, we usually say um to give it at least an hour to be received. If you haven't received it by the end of day today, um just give us a call and we'll be more than happy to send it to you again, um, but I'm sending it to you right now.
[CUSTOMER][POSITIVE] All right. Thank you so much, and uh, so that's all for today. Thank you so much for the information. So can I have the reference number?
[AGENT][NEUTRAL] So there's no call reference number for um the claim or the call, it would just be my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] All right, thank you so much and uh you have a great day ahead stay safe and happy weekend.
[AGENT][POSITIVE] You also, and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.