AccountId: 011433970860
ContactId: 1e8b4894-b6ab-487c-9334-9a253ce619e6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 781359 ms
Total Talk Time (AGENT): 242915 ms
Total Talk Time (CUSTOMER): 234458 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/1e8b4894-b6ab-487c-9334-9a253ce619e6_20250314T16:12_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] Hi, [PII]. My name is [PII] calling for claim status. How is your day going on?
[AGENT][NEUTRAL] My day is going well, [PII]. How was yours?
[CUSTOMER][NEUTRAL] Um, you're asking for callback number?
[AGENT][NEUTRAL] No, I thought you were asking me how my day was and I said mine is going well too, but yes, may I have a callback number?
[CUSTOMER][NEUTRAL] Sorry, sorry, sorry.
[CUSTOMER][NEUTRAL] Oh sorry, sorry. Um, great going. I, I missed out. Um, yes, a good callback number [PII].
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] That is going to be.
[CUSTOMER][NEUTRAL] 023893887.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] All right. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Numbers first and last name I have is [PII], date of birth, [PII].
[AGENT][POSITIVE] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And how may I assist you today?
[CUSTOMER][NEUTRAL] Requesting for claim status.
[AGENT][NEUTRAL] And may I have the um data service for the claim?
[CUSTOMER][NEUTRAL] That is going to be [PII] bill amount $179 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] That is MUSC physicians.
[AGENT][NEUTRAL] All right, so I'm showing that the claim was received.
[AGENT][NEUTRAL] Hold on one moment. On [PII], I'm sorry?
[CUSTOMER][NEUTRAL] On small
[CUSTOMER][NEUTRAL] Yes, I'm here. Sorry. Please go ahead.
[AGENT][NEUTRAL] Did you need the claim status?
[CUSTOMER][POSITIVE] Yes, yes, yes.
[AGENT][NEUTRAL] OK, so we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 351-6659.
[AGENT][NEUTRAL] And on [PII], um, the claim was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because this is not a covered loss under the plan. Therefore, there is no um amount payable.
[CUSTOMER][NEUTRAL] OK. You're setting that's a non-covered charges as for the patient's plan.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Can I have the business plan type?
[AGENT][NEUTRAL] Yes, this is the secondary insurance. Um, we apply to the co-pay, deductible and co-insurance of covered charges after primary.
[CUSTOMER][NEUTRAL] OK. That is uh patient as PPO plan or it's a more plan like that I'm asking.
[AGENT][NEUTRAL] I understand the question, but this is their secondary insurance. So that question applies to primary. The secondary insurance does not have a network.
[CUSTOMER][NEUTRAL] Secondary supplement plan.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you so much. Again, the supplement plan, we can keep it. OK. And uh
[CUSTOMER][NEUTRAL] Just to make sure the claim number 3516659, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Thank you. Can I have the call reference so that we can go with the next patient?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date.
[AGENT][NEUTRAL] The first initial to my last name is [PII].
[AGENT][NEUTRAL] And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Can you please spell your name?
[CUSTOMER][NEUTRAL] Uh yeah, 2 more.
[AGENT][NEUTRAL] OK, my name is [PII].
[CUSTOMER][POSITIVE] Thank you, [PII]. I'm ready with the next number.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Hold on one moment, let me note this policy.
[CUSTOMER][POSITIVE] Sure, sure. Take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] That is 02292666.
[AGENT][NEUTRAL] 02292666.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] 022, yes, yes, yes.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, I'm glad to do that for you. The patient's first name is, that is [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] Thank you for that, and again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] That is [PII]. Bill amount is $191 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And would the provider on this claim be the same or would it be a different provider?
[CUSTOMER][NEUTRAL] Same provider.
[AGENT][NEUTRAL] All right, so I'm showing received the claim on [PII].
[AGENT][NEUTRAL] That claim number is 354.
[AGENT][NEUTRAL] 2734.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] As office visits are not covered on this policy.
[CUSTOMER][NEUTRAL] OK. Of visits are not covered under the policy. Can I have the patient's plan name and plan type if possible?
[AGENT][NEUTRAL] Yes, this is the Medlink supplemental gap insurance.
[CUSTOMER][NEUTRAL] Meddling supplemental gap insurance, right? Meddling supplemental gap insurance. OK. Thank you. And uh
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] The call reference is going to be your name and today's date, right?
[AGENT][NEUTRAL] Yes, for the entire call.
[CUSTOMER][POSITIVE] Thank you. We'll go with the next last patient then.
[AGENT][NEUTRAL] Um, hold on one moment.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And the next member?
[CUSTOMER][NEUTRAL] That is going to be
[CUSTOMER][NEUTRAL] 022 05772.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] All right, take your time.
[AGENT][NEUTRAL] Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] And first and last name is [PII]. Date of birth, [PII].
[AGENT][POSITIVE] Thank you for that and the data service and total bills.
[CUSTOMER][NEUTRAL] That is to date of service, [PII], bill amount to $77 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] So I'm showing we received this claim on [PII].
[AGENT][NEUTRAL] The claim number is 351-7740.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] As office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] So same plan trip meddling supplemental gap plan.
[AGENT][NEUTRAL] Um, let me double check, yes.
[CUSTOMER][NEUTRAL] It's the same rate.
[AGENT][NEUTRAL] Yes, it's the same.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that's great for. One more quick second. Let me make sure.
[CUSTOMER][NEUTRAL] In all three cases, offices are not covered under the patient's plan, right?
[AGENT][NEUTRAL] I'm sorry, can you, can you repeat that slowly, please?
[CUSTOMER][NEUTRAL] In all the three claims, uh, offices are not covered under the patient's plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] OK. Can I have the last claim number 351-7740, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] But I'm unable to locate this claim in the portal. Can you please double-check, is that the correct claim number?
[AGENT][NEUTRAL] Sure, hold on one moment.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] The claim number is 0003517740.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But will you be able to locate this claim and [PII]?
[AGENT][NEUTRAL] Um, you should be able to access it still. Um, I believe it, it doesn't, uh, delete until a year.
[AGENT][NEUTRAL] If you're unable to access it.
[CUSTOMER][NEUTRAL] Actually, 351.
[CUSTOMER][NEUTRAL] Yes, actually, first two claims I was uh I was able to locate the UB portal.
[CUSTOMER][NEUTRAL] But for the 3rd time I'm able to get it in the portal. Um, when I enter this claim number, it is showing no claims.
[AGENT][NEUTRAL] Which claim number 351-7740 was the third one?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes, yes, but there is no claims found.
[CUSTOMER][NEUTRAL] In mind
[AGENT][NEUTRAL] Would you like me to fax you a copy of the explanation of benefits?
[CUSTOMER][NEUTRAL] OK. Will you be
[CUSTOMER][NEUTRAL] Kindly do that. Will you be able to send that copy via fax for me?
[AGENT][NEUTRAL] Yes, what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And do I need to put attention, [PII]?
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] And that's [PII]?
[CUSTOMER][POSITIVE] Perfectly correct.
[AGENT][POSITIVE] OK, I'll go ahead and send that over to you now. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] That's all for the day and that will take 24 hours, right, to receive it?
[AGENT][POSITIVE] Um, we can't really guarantee the facts, but, um, if you haven't received it by the end of business day today, you can give us a call and we'll be more than happy to resend it or on Monday if you'd like.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, that's great. Well, thank you. Um, great. That's all for today. Bye. Happy weekend. Take care. I have an office tomorrow.
[AGENT][POSITIVE] Thanks for calling APL thank have a good day. Bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.