AccountId: 011433970860
ContactId: 22b1aab2-6609-486d-b7b7-937898341f6d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 883039 ms
Total Talk Time (AGENT): 211091 ms
Total Talk Time (CUSTOMER): 275492 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/22b1aab2-6609-486d-b7b7-937898341f6d_20250616T15:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII], this is [PII] calling from provider's office to check up on a claim status. Also, this call has been recorded for quality and training purposes. Are you OK with that?
[AGENT][NEUTRAL] That's fine. I'm happy to check on a claim. What's the policy number for the patient?
[CUSTOMER][NEUTRAL] Sure, just give me a moment. Uh, you said your name is [PII]. Is it S [PII] Hotel? Is it [PII]?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK thank you um yeah the member ID would be 024.
[CUSTOMER][NEUTRAL] 08940.
[AGENT][NEUTRAL] I apologize. Can you repeat that one more time? 02.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 024.
[CUSTOMER][NEUTRAL] 08940.
[AGENT][NEUTRAL] Thank you. For documentation, do you have a good callback number, please?
[CUSTOMER][NEUTRAL] Yes, I do have. It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, member's name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] It's [PII] total charge $500 even.
[AGENT][NEUTRAL] Do you have anything different after primary paid?
[CUSTOMER][NEUTRAL] Um, it's $383.30.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] This claim was received [PII].
[AGENT][NEUTRAL] It was processed and paid on [PII]. There was a benefit payment sent in the amount of 38,330 as a single check.
[CUSTOMER][NEUTRAL] Can you help me with the claim, uh, payment details?
[AGENT][NEUTRAL] Check number is 2044665.
[CUSTOMER][NEUTRAL] And the address?
[AGENT][NEUTRAL] Check was sent to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can you also help me with the, uh, check clear date?
[AGENT][POSITIVE] A check is still showing outstanding.
[CUSTOMER][NEUTRAL] OK, so do you have any uh specific turnaround time for this one?
[AGENT][NEUTRAL] We can reissue the check if it's not uh been received.
[CUSTOMER][NEUTRAL] No, actually we didn't receive any payment yet, so that's why I'm asking you this.
[AGENT][NEUTRAL] Since it was issued 30 days ago, we can do a void reissue. Is the mailing address correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yeah, we can do a void and reissue on this.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][NEUTRAL] Is there anything else I can check?
[CUSTOMER][NEUTRAL] Can you help me with the claim number for this one? And I do have some more claims with me.
[AGENT][NEUTRAL] Claim number is gonna be 360-1735.
[CUSTOMER][NEUTRAL] 360-173-5, right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK. And um as you said, you're going to uh reissue the check. So how much time it will take?
[AGENT][NEUTRAL] At least 30 days.
[CUSTOMER][NEUTRAL] 30 calendar days or business days?
[AGENT][NEUTRAL] Calendar days.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Thank you so much. Can you help me with the call reference number for this number?
[AGENT][NEUTRAL] That would be my name with today's date.
[CUSTOMER][POSITIVE] OK, thank you so much, sir. Can, can we move to next number?
[AGENT][NEUTRAL] The next ID?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It would be 02.
[CUSTOMER][NEUTRAL] 29
[CUSTOMER][NEUTRAL] Followed by 3 consecutive 8.
[CUSTOMER][NEUTRAL] Number 3, M as in Mike. L as in Lima 8.
[AGENT][NEUTRAL] Name and date of birth?
[CUSTOMER][NEUTRAL] Um, yeah, member's name is uh [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Um, date of service is [PII]. Total charge $500 even.
[AGENT][NEUTRAL] Claim was received on [PII].
[AGENT][NEUTRAL] Claim was processed and denied [PII]. We need the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] Actually, we already submitted that on [PII].
[AGENT][NEUTRAL] I don't see anything on file for that date.
[CUSTOMER][NEUTRAL] Is it not on file?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, just give me a moment.
[CUSTOMER][NEUTRAL] OK, sure, no problem. I can resubmit that. Do you have any appeal filing limit for this one?
[AGENT][NEUTRAL] No appeal for this claim, no.
[CUSTOMER][NEUTRAL] So is there any um.
[CUSTOMER][NEUTRAL] A timely filing to submit primary GOB.
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] OK sure thank you.
[CUSTOMER][NEUTRAL] Can we move to next number?
[AGENT][NEUTRAL] What's the next ID?
[CUSTOMER][NEUTRAL] Next ID would be.
[CUSTOMER][NEUTRAL] 02563056
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEGATIVE] The disservice.
[CUSTOMER][NEUTRAL] It's [PII] total charge $500 even.
[AGENT][NEUTRAL] Do you have a different amount after primary paid?
[CUSTOMER][NEUTRAL] Yes, it's $150 even.
[AGENT][NEUTRAL] Claim is received [PII].
[AGENT][NEUTRAL] Claim was processed and a benefit payment was sent of $150 on [PII].
[AGENT][NEUTRAL] It's a single check, check number was 2045017.
[AGENT][NEUTRAL] Check was sent to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you help me with the claim number as well?
[AGENT][NEUTRAL] 36022887
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And this one, this check is also an outstanding.
[AGENT][NEUTRAL] Uh, one moment.
[AGENT][POSITIVE] Uh, yes, it does still show outstanding.
[CUSTOMER][NEUTRAL] So are you going to uh reissue this one as well?
[AGENT][NEGATIVE] It's not been received.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, we can do a reissue if it's not been received.
[CUSTOMER][POSITIVE] OK thank you.
[AGENT][NEUTRAL] Was there anything else that I can check on for you today?
[CUSTOMER][NEUTRAL] Um, can you help me with one another claim as well?
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] Yeah, just a moment.
[CUSTOMER][NEUTRAL] It would be 024.
[CUSTOMER][NEUTRAL] 62268.
[AGENT][NEUTRAL] I'm sorry, repeat that one more time. 0.
[CUSTOMER][NEUTRAL] 24.
[CUSTOMER][NEUTRAL] 62
[CUSTOMER][NEUTRAL] 268.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] It's [PII] total charge $5000 even.
[AGENT][NEUTRAL] Don't show any claims on file for that uh build them amount or data service.
[CUSTOMER][NEUTRAL] Can you check with a bill amount $5,594 even?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] But I do have um claim number.
[AGENT][NEUTRAL] Ends in 5866?
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] So this claim was denied requesting the primary EOB.
[CUSTOMER][NEUTRAL] Yeah, we have already submitted that on [PII].
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Claim is showing denied that the outpatient benefit max for the calendar year had already been met.
[AGENT][NEUTRAL] Which is $4000.
[CUSTOMER][NEUTRAL] $4000 per calendar year, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh when was this met?
[AGENT][NEUTRAL] Uh, looks like it was met on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is it under the same provider?
[AGENT][NEUTRAL] The last uh claim I'm showing was for a diagnostic women's center.
[CUSTOMER][NEUTRAL] Under the same provided.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][POSITIVE] OK, sure, thank you so much. Can you help me with the claim number or is it the same?
[AGENT][NEUTRAL] Uh, the claim number is 3602893.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] You're welcome, Mrs.
[CUSTOMER][POSITIVE] Thank you so much, [PII], for your help.
[AGENT][POSITIVE] You're welcome have a good day.
[CUSTOMER][POSITIVE] Bye bye take care.
[AGENT][NEUTRAL] Mhm. Bye-bye.