AccountId: 011433970860
ContactId: 28511936-f68e-41a7-bba6-f077cf585c7a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1400459 ms
Total Talk Time (AGENT): 238252 ms
Total Talk Time (CUSTOMER): 453480 ms
Interruptions: 6
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/28511936-f68e-41a7-bba6-f077cf585c7a_20250214T18:34_UTC.wav
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[CUSTOMER][NEUTRAL] Hello, this is [PII] from Bluevir's office to check on the status of claim for one patient.
[AGENT][NEUTRAL] OK [PII], I can help you with the status of the claim. um, can you please give me your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah, it's [PII], and it's a direct line.
[AGENT][NEUTRAL] Thank you sir and then what is the patient's name?
[CUSTOMER][NEUTRAL] And what type of plans do you have?
[CUSTOMER][NEUTRAL] Yeah, first name would be [PII] and the last name is [PII].
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] OK, and what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Yeah. Uh, just quickly checking for the date of birth.
[CUSTOMER][NEUTRAL] All right
[CUSTOMER][NEUTRAL] for.
[CUSTOMER][NEUTRAL] Give me just one second, yeah.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] So, it is [PII].
[AGENT][NEUTRAL] Thank you and what's the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, it is 16995.
[AGENT][NEUTRAL] OK, that that's not one of our policy numbers. Do you see another number?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Is there any way, can you check with patient name, date of birth?
[CUSTOMER][NEUTRAL] You just a lot of water.
[AGENT][NEUTRAL] Yes, can you spell the first name for me?
[CUSTOMER][NEUTRAL] Yeah, it's [PII], which is [PII] is the first name.
[CUSTOMER][NEUTRAL] And [PII], [PII]. That's, that was the last name.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, [PII] would be [PII], yeah. [PII], then there is a space and [PII].
[AGENT][NEUTRAL] OK, can
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Let me look that up real quick.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me know when.
[AGENT][NEUTRAL] OK, I am not finding that patient in our system.
[CUSTOMER][NEUTRAL] The number is [PII]. Uh, OK, so.
[CUSTOMER][NEUTRAL] And is there, is there any other way to locate this member?
[AGENT][NEUTRAL] If you have the social security number, I can try that way.
[CUSTOMER][NEUTRAL] OK. Because, you know what, I do have a patient. OK. Wait one second. I just, uh, I mean, I do have a patient's member ID card, OK.
[CUSTOMER][NEUTRAL] And in that, uh, it shows me the same.
[AGENT][NEUTRAL] OK, yes.
[CUSTOMER][NEUTRAL] Yeah, it, it is belong to an APL, American Public Life. I, I have [PII], the name of the member, and I believe the group, it was group number 16995.
[CUSTOMER][NEUTRAL] And it shows effective from [PII]. Yeah, plan was Meslick, uh Men's select group medical supplemental plan. And I do have a member, uh there is uh in the hospitals benefit certificate number, I mean, in, in the hospital benefit certificate number I have.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, give me that.
[CUSTOMER][NEUTRAL] So, which one you want, like you require, in hospital or outpatient?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I have to
[AGENT][NEUTRAL] Either one.
[CUSTOMER][NEUTRAL] Either one? OK. So, in hospitals benefit certificate number, it's 01542275. M as in Mike, L Lima number 7. Yes, and uh.
[AGENT][POSITIVE] OK, let me look that up. That sounds like a good number.
[CUSTOMER][NEUTRAL] Yeah. And shows uh the insured name [PII] in that member ID card. Coverage was individual group number 16995.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I do have the member pulled up.
[CUSTOMER][POSITIVE] Uh, no problem.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said you were looking for um claim status?
[CUSTOMER][POSITIVE] That's right. Mhm.
[AGENT][NEUTRAL] OK, what is the date of service?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] And do you require the charge mode as well?
[AGENT][NEUTRAL] And the charge amount?
[CUSTOMER][NEUTRAL] Yeah, checking for the charge amount which is $491 even.
[AGENT][NEUTRAL] The charges after primary paid their part?
[CUSTOMER][NEUTRAL] Yeah, um, and, uh, primary had paid. BCBS, uh, is the insurance. They had the primary on it. They applied deductible and that amount was billing to you guys.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So what is the charge amount after primary paid their part?
[CUSTOMER][NEUTRAL] I mean, uh, they applied $189.
[CUSTOMER][NEUTRAL] Deductible
[CUSTOMER][NEUTRAL] And that amount was billed to you guys.
[AGENT][NEUTRAL] $9 OK. And then what is the name of the facility that you're calling from?
[CUSTOMER][NEUTRAL] Uh, yeah, it is MD now Medical Center.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold [PII] while I pull in this claim for you and I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK [PII], I have found the claim for you. The claim number is 354.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 9114.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] The claim was paid $189.
[CUSTOMER][NEUTRAL] Wait, wait, uh, voice little breaking.
[CUSTOMER][NEUTRAL] Uh, voices a little breaking? Can, what was the process that you said?
[AGENT][NEUTRAL] OK, I'll give you a process date in just one second.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it was reported on [PII]. Claim was processed on [PII].
[CUSTOMER][NEUTRAL] I'm trying
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the allowed amount?
[AGENT][NEUTRAL] Claim was paid $189.
[AGENT][NEUTRAL] With check number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the check issue date.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK. Uh, is, is this one is a single or a bulk check?
[AGENT][NEUTRAL] Single
[CUSTOMER][NEUTRAL] OK. And what was the check mailing address?
[AGENT][NEUTRAL] Let me look for you real quick.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I you.
[AGENT][NEUTRAL] It was mailed to MD now [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] When I gotta be.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, you said [PII]?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] OK. [PII], right? [PII], correct?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII], yes.
[CUSTOMER][NEUTRAL] And do you have a
[CUSTOMER][NEUTRAL] OK. This check has been cashed or not? Do you have details?
[AGENT][POSITIVE] No, it's still outstanding.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So, like, like, do you have the exact date or like you do not have the cash detail like right now? What exactly you uh showing?
[AGENT][NEUTRAL] We
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] I do not have cash detail it's outstanding.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh, OK. Can you just send check tracer on it to get this details?
[CUSTOMER][NEUTRAL] I check sir, for this.
[AGENT][NEUTRAL] Yes, the status of the check.
[AGENT][NEUTRAL] The check is outstanding and it was issued on October, I'm sorry, [PII].
[CUSTOMER][NEUTRAL] It's not
[CUSTOMER][NEUTRAL] Yeah, yeah. So, can you just place a check with the detail in order to get this detail when this check has been cashed?
[AGENT][NEGATIVE] It has not been cashed.
[AGENT][POSITIVE] It's outstanding.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, give me one sec.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh, and the claim number for this, what you said?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 354-911-4.
[CUSTOMER][NEUTRAL] 254-911-4. Correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] OK, OK. Just, uh, can you give me one second? I need to just make it correct on it.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Oh, OK. So, you know what, uh, the thing is, I do not have a check, uh, payment for this, and, uh,
[CUSTOMER][NEUTRAL] We do not have a detail like, you know, for this payment yet, so.
[CUSTOMER][NEUTRAL] Can you just uh reissue a new check or can you place a check er to get the cash details?
[CUSTOMER][NEUTRAL] If you help me on that, then we can find our payment because from our end, I will just double-check with this payment what you have provided me, uh, with the check number [PII]. We are unable to find this payment. So can you just place a check traer on it?
[AGENT][POSITIVE] Yes, um, if you put if can put you on hold I'll get that taken care of for you.
[CUSTOMER][NEUTRAL] OK, all right.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Lord, have [PII] on me.
[AGENT][POSITIVE] It's going to be a good day.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK [PII], I have that request in to have the I have a request in to void and reissue that check to your company.
[CUSTOMER][NEUTRAL] Yes, hello.
[CUSTOMER][NEUTRAL] Uh, you placed for a wide on it?
[AGENT][NEGATIVE] No, I have a request to void it and reissue.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, the check, OK.
[CUSTOMER][NEUTRAL] Uh, all right. So what was the turnaround time for this?
[AGENT][NEUTRAL] 7 to 10 business days.
[CUSTOMER][NEUTRAL] OK. All right.
[CUSTOMER][POSITIVE] So we will get a new EUB on it for this.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] The EOB will remain the same. The check is just going to be reissued.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, OK. So, for this time, uh, can you send me the EOB into my secured fax number?
[AGENT][NEUTRAL] Yes, uh, what is your fax number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Or do, do we have any kind of open portal where I can check from my end for this COB?
[AGENT][NEUTRAL] We have a portal at secured.
[AGENT][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you would have to put in the patient account number.
[CUSTOMER][NEUTRAL] Uh, is it open?
[CUSTOMER][NEUTRAL] OK. It's an open portal?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Like user ID password will require on it?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, then you can make a request on this, which is
[CUSTOMER][POSITIVE] For the fax number. I'm just providing you quickly on it.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh, just having my updated one, which is
[CUSTOMER][NEUTRAL] Yeah. All right. It is 833648-4832.
[AGENT][NEUTRAL] OK, let me repeat it. 8336484832.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] That's right. Mhm.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I fax that over to you. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], I have that fax on its way to you now.
[CUSTOMER][NEUTRAL] OK. All right. So just need the reference number for the call and how do you spell your name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Yeah, and the reference number for the call?
[AGENT][NEUTRAL] It's gonna be my name and today's date.
[CUSTOMER][POSITIVE] OK. All right. Thank you. Thank you so much for your support. Have a nice day.
[AGENT][POSITIVE] You too you have a good weekend and thanks for calling APL.
[AGENT][NEUTRAL] Bye-bye, sir.
[CUSTOMER][POSITIVE] You as well. Thank you.