AccountId: 011433970860
ContactId: 1af21efd-1f51-40f0-bf6d-fc9f3da94eee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 584330 ms
Total Talk Time (AGENT): 214886 ms
Total Talk Time (CUSTOMER): 161550 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/1af21efd-1f51-40f0-bf6d-fc9f3da94eee_20250610T17:54_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] Uh, I'm [PII] from the provider's office. Uh, I want to check a claim.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][POSITIVE] Yeah, correct.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] What are the last 4 numbers?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] And by [PII].
[AGENT][NEUTRAL] What is the member's policy number?
[CUSTOMER][NEUTRAL] 245-0908
[AGENT][NEUTRAL] 245-0908. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And any information that is provided, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's uh [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] And I'm sorry, what was the first name again?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] OK, thank you and the last name again? That's OK and the last name spell that for me.
[CUSTOMER][NEUTRAL] I don't know how to spell it.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Bill on $365.
[CUSTOMER][NEUTRAL] Even
[AGENT][NEUTRAL] OK, thank you. And again, [PII] any information provided will be a verification of benefits and not a guarantee of payment. One moment.
[AGENT][NEUTRAL] And that was [PII], is that correct?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], is that the correct data service one?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII], like last year, and the full amount $364 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim was received on [PII].
[CUSTOMER][NEUTRAL] And patient active for the date of service, ma'am?
[AGENT][NEUTRAL] And it was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3476344.
[AGENT][NEUTRAL] And the reason for the denial on this claim [PII] states calendared your maximum on diagnostic services has been met.
[CUSTOMER][NEUTRAL] Can you repeat it?
[AGENT][NEUTRAL] Calendar year maximum on diagnostic services has been met.
[CUSTOMER][NEUTRAL] Can you repeat one more time? I'm really sorry, calendar year.
[AGENT][NEUTRAL] Calendar year maximum.
[AGENT][NEUTRAL] On diagnostic services.
[AGENT][NEUTRAL] Has been met.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Can I get the EOB of this EOB?
[AGENT][NEUTRAL] Yes ma'am, or do you have the ability to print from our portal, [PII], because our portal is located at [PII]?
[CUSTOMER][NEUTRAL] Can you fax it?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] You can't print.
[CUSTOMER][NEUTRAL] Uh, currently the portal is locked. That's why I called.
[CUSTOMER][NEUTRAL] And yeah, we have common.
[AGENT][NEUTRAL] Logged
[CUSTOMER][NEUTRAL] Yeah, we cannot log into that. It's like, uh, that existing email address, but I think we have like a username, yeah.
[AGENT][NEUTRAL] And you're trying to log in as a provider?
[CUSTOMER][POSITIVE] Yeah, that's the provide, yes.
[AGENT][NEUTRAL] One moment, [PII], and I wanna look at something.
[CUSTOMER][NEUTRAL] I guess you know.
[CUSTOMER][NEUTRAL] I do, uh.
[CUSTOMER][NEUTRAL] There is no option to choose as a provider or patient, no?
[AGENT][NEUTRAL] So I'm not sure where you're located, but that's not you should be, once you select to create an OSC account to create your OSC account.
[AGENT][NEUTRAL] Then you would select provider.
[CUSTOMER][NEUTRAL] You mean the account name?
[CUSTOMER][NEUTRAL] The date
[AGENT][NEUTRAL] And ma'am, you need to go to the first screen. It's
[CUSTOMER][NEUTRAL] So, it's [PII], no?
[AGENT][NEUTRAL] This, again, the website, no ma'am, the website that you go to for our portal is secured.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEGATIVE] Yeah, that's the one I tried. Uh our logins are not working.
[AGENT][NEUTRAL] Mhm and you would do create your you name you're gonna select create your OSC account.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you would select provider under which role best describes you.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And click next.
[CUSTOMER][NEUTRAL] Hold on, I click.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Next,
[AGENT][NEUTRAL] Mhm. And you will enter the tax ID number for the provider.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Tax ID.
[CUSTOMER][NEUTRAL] Yes, OK, I add it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then
[CUSTOMER][NEUTRAL] Mhm continue then.
[CUSTOMER][NEUTRAL] Oh, you mean you, I had to create the one.
[AGENT][POSITIVE] Yes, ma'am, you do.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I don't think I can do that without the provider's permission.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Is there any other way I can get the UOP UB UP?
[AGENT][NEUTRAL] I'm going to fax it to you, [PII]. I'm going to fax it to you just one moment. Mhm.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Go ahead and give me your fax number, [PII], while this is loading.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And does it need to be put to your attention, [PII]?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And again, you said your fax number is [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yes, it's correct.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, [PII], so I have just faxed that explanation of benefits to you, so you should be receiving that very soon.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much. Uh, all I need is a reference number for this call.
[AGENT][NEUTRAL] Yes, ma'am, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] Uh, your name? I'm sorry, I forgot.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And initial last name?
[AGENT][NEUTRAL] [PII], and [PII]?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And is there again, [PII], anything else I can help you with today?
[CUSTOMER][POSITIVE] Uh, no, that's all, thank you so much.
[AGENT][POSITIVE] OK, well, you're welcome and thank you for calling APL. I hope you have a nice afternoon.
[CUSTOMER][POSITIVE] You too. Have a great day. Thank you, bye.
[AGENT][POSITIVE] Thank you. You too. Bye-bye.