AccountId: 011433970860
ContactId: 2969a0c1-062c-4335-924e-ff52644ac743
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 638659 ms
Total Talk Time (AGENT): 180418 ms
Total Talk Time (CUSTOMER): 197476 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/2969a0c1-062c-4335-924e-ff52644ac743_20250521T15:25_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] Mhm.
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] from provider's office checking on the claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII], and may I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] Sure. That is [PII].
[CUSTOMER][NEUTRAL] And uh the member ID is
[CUSTOMER][NEUTRAL] D as in Delta 46701701.
[AGENT][NEUTRAL] OK, and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] I have 2 claims.
[AGENT][NEUTRAL] OK, and do you have a copy of the member's ID card available?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] On the card, do you see anywhere that says in hospital or outpatient policy er number?
[CUSTOMER][NEUTRAL] Just give me a moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, I can't find the.
[CUSTOMER][NEUTRAL] Any information like that, uh?
[AGENT][NEUTRAL] OK, so that
[AGENT][NEUTRAL] That D number is the policy number for 90 Degree benefits. Um, may I have either the member's first and last name or their full social if you have it?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Sure. First name is
[CUSTOMER][NEUTRAL] [PII], it's [PII]
[CUSTOMER][NEUTRAL] And the last name is [PII]. It's [PII] And the date of birth is [PII].
[AGENT][NEUTRAL] He's not the
[CUSTOMER][NEUTRAL] And the social security number is?
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK. The Social Security number is [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] All right, so I believe I just located the policy. Hold on one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Alright, and thank you so much for verifying his date of birth. Um, so all the information provided is a verification of benefits, not a guarantee of payment, and I am showing the um policy number is 2506092.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Sure. That is [PII] and the bill amount is $260 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Sure. That is Moses Health on Memorial Hospital.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] So I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 3938.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim a total of $50.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] To the provider.
[CUSTOMER][NEUTRAL] Any special responsibility?
[AGENT][NEUTRAL] Uh, we don't determine patient responsibility because we're not the major medical insurance company.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you have the payment details with you?
[AGENT][NEUTRAL] Sure, hold on one moment, let me get that for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it was a single check in the amount of $50.
[AGENT][NEUTRAL] The check number is 201.
[AGENT][NEUTRAL] 2480.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. Uh, so for this claim, any denial?
[AGENT][POSITIVE] There's no denial the max benefit was paid to this claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So maximum allowed you, I mean allowed amount is 50, right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII], and I have uh one more claim for different members, shall I?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Mhm. That is D as in Delta 43510336.
[AGENT][NEUTRAL] OK, do you have a copy of the member's ID card available, that the number is for a different company.
[CUSTOMER][NEUTRAL] OK. May I provide you the uh social security number?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Social security number is
[CUSTOMER][NEUTRAL] It's consecutive
[CUSTOMER][NEUTRAL] It's consecutive [PII].
[AGENT][NEUTRAL] What do you mean consecutive [PII], how many consecutive nines?
[CUSTOMER][NEUTRAL] Uh, no, it's uh [PII]. It's [PII]. Yes.
[AGENT][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] That's not a social. Um, what's the member's first and last name?
[CUSTOMER][NEUTRAL] OK. It's
[CUSTOMER][NEUTRAL] [PII], it's [PII]
[CUSTOMER][NEUTRAL] Last name is [PII]. It's a
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So I'm just waiting for the um policies to populate here. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the last name is [PII]
[CUSTOMER][NEUTRAL] Yes, right.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I'm not showing a policy on file with um the member's first or last name.
[CUSTOMER][NEUTRAL] OK. Um, may I provide you the claim number which was paid for this member?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. That is 202409.
[CUSTOMER][NEUTRAL] 0, I'm sorry, 202409190127.
[AGENT][NEUTRAL] So this may have been submitted to primary insurance, um, but that's not an APL claim number. I will double check it just to make sure, but um that's too long for us. Hold on one moment.
[AGENT][NEGATIVE] Yeah, it won't even fit in the field. Um, so maybe this was uh presented or billed to major insurance if they have a major secondary, um.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] But that was not built to APL. We don't have that member in our system.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII]. Can I get the call reference number, please?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you so much for your assistance and patience. Have a nice day, bye.
[AGENT][POSITIVE] You also [PII] and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm. OK.