AccountId: 011433970860
ContactId: 1c257450-f7a2-4aa5-ade7-67bf98c7d65c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 595219 ms
Total Talk Time (AGENT): 188891 ms
Total Talk Time (CUSTOMER): 146740 ms
Interruptions: 2
Overall Sentiment: AGENT=2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/1c257450-f7a2-4aa5-ade7-67bf98c7d65c_20250407T12:13_UTC.wav
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[CUSTOMER][NEUTRAL] And it's just so.
[AGENT][NEUTRAL] Good morning. Thank you for calling APOs. This is [PII].
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] [PII], how can I help you?
[CUSTOMER][NEUTRAL] Hi, your name is [PII]?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes, can you hear me?
[AGENT][NEUTRAL] No, [PII]
[CUSTOMER][NEUTRAL] Oh, hi, [PII]
[AGENT][POSITIVE] Yes, ma'am, I can.
[CUSTOMER][NEUTRAL] Uh, my name is [PII]. I'm calling to check status on the claim.
[AGENT][NEUTRAL] OK, [PII], you have one claim that you're needing to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the member's policy in place, [PII]?
[CUSTOMER][NEUTRAL] I have 01838943.
[AGENT][POSITIVE] Thank you. One moment, please.
[AGENT][NEUTRAL] OK, [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] OK, this is um [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] The date of service is [PII]. I have $8560.71.
[AGENT][NEUTRAL] OK, can you repeat the amount one more time, please?
[CUSTOMER][NEUTRAL] 8500.
[AGENT][NEUTRAL] 800 uh-huh.
[CUSTOMER][NEUTRAL] $8560.71
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And you said the year is [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I do see that this claim was out, the received date was [PII] and it was processed on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And so
[AGENT][NEUTRAL] The claim number is going to be.
[CUSTOMER][NEUTRAL] I'm sorry. It
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Claim number
[AGENT][NEUTRAL] Were you able to hear that?
[AGENT][NEUTRAL] Are you able to hear me OK, [PII]?
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Yeah, you're breaking up. So I got that the claim was received [PII]. It processed on [PII] and you proceeded with the claim number.
[AGENT][NEUTRAL] So, did you receive, did you get all the claim number?
[CUSTOMER][NEGATIVE] I didn't get the claim number.
[AGENT][NEUTRAL] 353-312-6
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim was denied.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the reason for the denial?
[AGENT][NEUTRAL] Is that we are, we need a copy of the primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] It states, please provide copies of your explanation.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] And you're showing the other insurance as Blue Cross?
[AGENT][NEUTRAL] Uh, we would not be a major medical. We're not gonna be a primary. This is strictly.
[CUSTOMER][NEGATIVE] I'm sorry. You, you keep breaking up.
[AGENT][NEUTRAL] A supplemental policy. Let me check to see what we had on.
[AGENT][NEUTRAL] Yes, ma'am, and I can't do anything about that. I'm so sorry. It's something within the phone system.
[AGENT][NEUTRAL] At the time,
[CUSTOMER][NEUTRAL] OK, you said this is a supplement. OK.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] At the time that she had coverage with us, yes, it showed Blue Cross.
[CUSTOMER][NEUTRAL] OK. And you said this is a supplemental policy?
[AGENT][NEUTRAL] That is correct. We are not a major medical carrier.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] All right. Now, question, [PII], did the EOB go out stating it was requesting the um
[AGENT][NEUTRAL] It was.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] And the EOB went out on [PII]?
[AGENT][NEUTRAL] It went out on the day after the process date.
[AGENT][NEUTRAL] Now you can also print this and the explanation of benefits, [PII], now that you have the claim number by going to our portal which is located at [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Now, do I have to register and all that?
[AGENT][NEUTRAL] Yes, ma'am, it's a self-registering portal.
[CUSTOMER][NEGATIVE] Uh, OK, it's just this is my only one. I hate going through all of that for one claim. Um, there's no way you can, um, fax over the EOB to me?
[AGENT][NEUTRAL] Sure, just a moment.
[CUSTOMER][NEUTRAL] 3
[AGENT][NEUTRAL] OK. Give me just a few minutes to get that loaded, please.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And [PII], can I get the first initial of your last name?
[AGENT][NEUTRAL] Will it need to be put to your attention?
[AGENT][NEUTRAL] Yes and also yours.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] What is yours?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] Yes, ma'am. I got it.
[CUSTOMER][NEUTRAL] OK. Now, my fax number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, just a moment, it's still loading.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And again, [PII], you said the fax number is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, so I have just faxed that to you. So provided there's not any type of technical glitch, you should be receiving that very soon.
[CUSTOMER][NEUTRAL] OK, and just one more question, I need to verify the claim number. I have 353-312-6 correct?
[AGENT][POSITIVE] That is correct. Yes, ma'am.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII] and one other question, do you guys provide call reference numbers?
[AGENT][POSITIVE] Yes, ma'am. You came along with today's date.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII]. Have a good day.
[AGENT][POSITIVE] You are, yes, me too. Is there anything else that I can help you with, [PII]?
[CUSTOMER][POSITIVE] Uh no, that's it. Thank you.
[AGENT][POSITIVE] OK, well, you're welcome.
[CUSTOMER][NEUTRAL] All right. Bye-bye.
[AGENT][POSITIVE] And thank you again for calling APL. I hope you have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.