AccountId: 011433970860
ContactId: 1e565ee8-ac42-4a7c-8625-7fda16e29ffa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1504469 ms
Total Talk Time (AGENT): 193253 ms
Total Talk Time (CUSTOMER): 636566 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/1e565ee8-ac42-4a7c-8625-7fda16e29ffa_20250604T15:33_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from Envision. Could you please help me with the claim status?
[AGENT][NEUTRAL] Happy to check a claim, [PII]. What is the policy number?
[CUSTOMER][NEUTRAL] The policy number is
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] 02473
[CUSTOMER][NEUTRAL] 403 M as in Mike. L as in Lima.
[CUSTOMER][NEUTRAL] 8.
[AGENT][NEUTRAL] Repeat that back to me one more time, please.
[CUSTOMER][NEUTRAL] OK, deal. It's 02473403. M as in Mike, L as in Lima, number 8.
[AGENT][POSITIVE] Thank you. Do you have a good callback number?
[CUSTOMER][NEUTRAL] The good callback number is [PII] and the extension will be [PII].
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] OK, it's uh
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the last name is [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] The date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] The date of service is
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Fill them out.
[CUSTOMER][NEUTRAL] The bill amount.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, just give me a second. Uh, can I say the total charge amount?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, what, what do you have as a charge amount?
[CUSTOMER][NEUTRAL] It's 2444.
[CUSTOMER][NEUTRAL] Even
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Alright, so we did receive a claim for the state of service on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim is processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim was denied that the maximum mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. Actually, uh, our
[CUSTOMER][NEUTRAL] Associated uh called on uh
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] For the same reason and your the
[CUSTOMER][NEUTRAL] Rep uh stated uh the rep name is [PII].
[CUSTOMER][NEUTRAL] Uh she also stated that the maximum benefit has met and we requested an EOB until now we didn't got that. Could you please solve this?
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] Our fax number is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Just to confirm that was [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, see you.
[AGENT][NEUTRAL] Should we mark attention to anybody?
[CUSTOMER][NEUTRAL] Uh, it's my name, [PII].
[AGENT][NEUTRAL] OK. [PII] should be there in about 5 minutes. Is there anything else I can check on for you?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh, if you don't mind, I have other claim. Could we go with that if you're OK.
[AGENT][NEUTRAL] Let me just finish notating this one moment.
[CUSTOMER][NEUTRAL] OK, OK, dear.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] For this, can I get the call reference number if you are?
[AGENT][NEUTRAL] Call reference is my name with today's date. My name again is [PII], that's [PII] and then today's date.
[CUSTOMER][NEUTRAL] If you don't mind.
[CUSTOMER][NEUTRAL] Could you please uh spell your name uh in phonetics?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And they said.
[AGENT][POSITIVE] I'm ready for the next policy number when you are.
[CUSTOMER][NEUTRAL] A.
[CUSTOMER][NEUTRAL] OK, just give me a second, dear.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Just give me a second if you don't mind.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I didn't
[CUSTOMER][NEUTRAL] By the way, how was your day going on, [PII]?
[AGENT][POSITIVE] So far so good. Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, let me go with the next ID.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's uh
[CUSTOMER][NEUTRAL] X as in X oh sorry.
[CUSTOMER][NEUTRAL] 025
[CUSTOMER][NEUTRAL] 0500.
[CUSTOMER][NEUTRAL] 4 M as in Mike. L as in Lima.
[CUSTOMER][NEUTRAL] Number 8
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] The name is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The name of the member is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Let me say the last uh name.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] Date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] The date of service is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Fill them out.
[CUSTOMER][NEUTRAL] OK. The total charge amount is $1,504 even.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] OK, so it looks like the claim was received on [PII].
[CUSTOMER][NEUTRAL] Just give me a second.
[CUSTOMER][NEUTRAL] Uh, it was received on?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And it is got paid.
[CUSTOMER][NEUTRAL] Uh the night.
[AGENT][NEGATIVE] It was denied.
[CUSTOMER][NEUTRAL] May I know the reason why?
[AGENT][NEUTRAL] We need the primary explanation of benefits.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and uh
[CUSTOMER][NEUTRAL] If we have, can we fax that, right? Let me check.
[AGENT][POSITIVE] Yes, you can.
[CUSTOMER][NEUTRAL] Let me check once again.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] May I know, uh, could you please check that who is the primary for this patient?
[AGENT][NEUTRAL] We do not have that information. You would have to check with the insured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what else do you need uh for this?
[AGENT][NEUTRAL] That's all that's needed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just give me a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, can we go with the, the patient? Uh, just give me a second, till then I will be noting this one.
[CUSTOMER][NEUTRAL] OK, [PII]. Uh just give me a second. I'm checking the other patient.
[CUSTOMER][NEUTRAL] Uh, [PII], can we go with the patient if you're OK?
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] OK, let me say that.
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] Uh, it's
[CUSTOMER][NEUTRAL] 74
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 155742
[CUSTOMER][NEUTRAL] 013.
[AGENT][NEUTRAL] That's too long to be one of our policy numbers.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, I will say you again. Could you please check with that 740-155.
[CUSTOMER][NEUTRAL] 742.
[CUSTOMER][NEUTRAL] 013.
[AGENT][NEUTRAL] It doesn't bring up anything.
[CUSTOMER][NEUTRAL] OK, let me check uh with other number. Just give me a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I to.
[CUSTOMER][NEUTRAL] Like we have this number only for the patient.
[AGENT][NEUTRAL] I can check my name or social if you have that.
[CUSTOMER][NEUTRAL] OK. Let me say the member's name is [PII] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] And uh OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What state does the patient live in?
[CUSTOMER][NEUTRAL] Patient state.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, just give me a second.
[CUSTOMER][NEUTRAL] I will check the address.
[CUSTOMER][NEUTRAL] It is uh [PII].
[CUSTOMER][NEUTRAL] Right, I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] I'm not able to locate a plan under that name.
[CUSTOMER][NEUTRAL] OK. OK, dear. Uh, just give me a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] If you're OK, can we go with the other member also?
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] Just give me a second. I will be clearing this and saying you the other number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 090853.
[CUSTOMER][NEUTRAL] And the other member ID is
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It's 0170.
[CUSTOMER][NEUTRAL] 259
[CUSTOMER][NEUTRAL] 7
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima.
[CUSTOMER][NEUTRAL] 8.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] What's the date of birth?
[CUSTOMER][NEUTRAL] The date of birth is [PII].
[AGENT][NEUTRAL] And the policy number was 01772597.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] That doesn't match the information provided. 01772597.
[CUSTOMER][NEUTRAL] Yes, 01702597. M as in Mike, L as in Lima, and 8.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, OK, what's the date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] Filled them out.
[CUSTOMER][NEUTRAL] The bill amount is 3,384.00 cents.
[AGENT][NEUTRAL] Do you have a different amount after primary you paid?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Give me a second. Let me check and see.
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, the primary.
[CUSTOMER][NEUTRAL] Uh, no, uh.
[CUSTOMER][NEUTRAL] There is no payments.
[AGENT][NEUTRAL] OK, no claims on file for that bill amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just give me a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me check once again.
[CUSTOMER][NEUTRAL] OK. Uh, it's 2694.
[CUSTOMER][NEUTRAL] 090.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] For
[AGENT][NEUTRAL] Are you asking for the claims mailing address?
[CUSTOMER][NEUTRAL] No, no, uh, it's not uh claims mailing address, uh, that, uh, we have built.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] It uh it was a leftover balance.
[AGENT][NEUTRAL] Of how much?
[CUSTOMER][NEUTRAL] It is 2694.
[CUSTOMER][NEUTRAL] 190.
[AGENT][NEUTRAL] We don't have any, yeah, we don't have any.
[CUSTOMER][NEUTRAL] It was uh motor deductible.
[AGENT][NEUTRAL] We don't have any claims on file for that amount.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just give me a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], give me a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, [PII], sorry for the inconvenience. Can I get the call reference for today?
[AGENT][NEUTRAL] Call reference is my name with today's date. My name is [PII], that's [PII]. Initial to my last name is [PII], then today's date.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, thank you so much and have a good day.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][POSITIVE] Enjoy your day.