AccountId: 011433970860
ContactId: 32e94daf-2276-422f-a738-af01475862eb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 435869 ms
Total Talk Time (AGENT): 177029 ms
Total Talk Time (CUSTOMER): 114785 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/32e94daf-2276-422f-a738-af01475862eb_20250411T14:59_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 to check on a claim.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim, [PII]. May I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII] it's a direct line.
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] 1456796.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] I'll spell out it's [PII] [PII] [PII] [PII], [PII].
[CUSTOMER][NEUTRAL] Last name [PII]. And the date of birth, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment, and you said this is for claim status, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] The date of service is [PII]. It's a single date range.
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] $3,497.36.
[AGENT][NEUTRAL] Thank you and again just for the call, the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment while I locate the claim for you.
[CUSTOMER][NEUTRAL] Mhm. Sure.
[AGENT][NEUTRAL] Can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Rapist Medical.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Claim number is 349.
[AGENT][NEUTRAL] 5844.
[AGENT][NEUTRAL] And on [PII], the claim was denied, requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Uh, could you please help me with the date again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] All right, one moment.
[CUSTOMER][NEUTRAL] And could we have previously sent the primary insurance explanation of benefits. Could you please check, have you received it on your end?
[AGENT][NEUTRAL] When did you send it?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I could see that was faxed it on [PII].
[AGENT][NEUTRAL] Yes, and it's currently in process and we did receive it on [PII].
[CUSTOMER][NEUTRAL] Is, is that you have received it?
[AGENT][NEUTRAL] Yes, we, we have received it as of [PII]. It's in processing.
[AGENT][NEUTRAL] So once we finish processing, you'll receive a new decision.
[CUSTOMER][NEUTRAL] And may I know the turnaround time?
[AGENT][NEUTRAL] 7 to 10 business days.
[AGENT][NEUTRAL] From the date that we received it.
[CUSTOMER][POSITIVE] Thank you so much. And do you have any document number?
[AGENT][NEUTRAL] Um, this is, there's no document number.
[CUSTOMER][NEUTRAL] All right. Can I get a reference number for a call?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name at today's date, and again, that's [PII] to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you so much, [PII], for your assistance. Have a great day. Bye-bye. Thank you.
[AGENT][NEUTRAL] You're welcome. Hold on one moment.
[AGENT][NEUTRAL] I'm just looking at the documents that were received.
[AGENT][NEUTRAL] Hold on 1 2nd.
[CUSTOMER][NEUTRAL] Mhm. Sure.
[CUSTOMER][NEUTRAL] to
[AGENT][NEUTRAL] Yeah, this, this, um,
[AGENT][NEGATIVE] What was received on [PII] is not the explanation of benefits for this claim, but we did receive something on [PII], but this is not, this is not for her. So no, we have not received. I just want to make sure, I'm glad I checked that. Um, no, something did come in on [PII], but it is not um.
[AGENT][NEUTRAL] Let me see who this came from. This is a totally different member. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] I don't know if this was sent in error.
[AGENT][NEUTRAL] Because this person.
[CUSTOMER][NEUTRAL] All right, and you want us to resend it?
[AGENT][NEUTRAL] Yes, you, you definitely need to resend it because this is a totally different member.
[AGENT][NEUTRAL] So I don't, I don't
[CUSTOMER][NEUTRAL] All right. And could you please help me with the name?
[AGENT][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] I was just trying to let you know what was received. Go ahead.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Yes, no problem. Go ahead, please.
[AGENT][NEUTRAL] What, um, you were asking for the fax number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, uh, for resubmitting for my documentation, could you please help me with the mailing address and fax number?
[AGENT][NEUTRAL] Sure, our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Our zip code is [PII].
[AGENT][NEUTRAL] And the fax number is [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you so much. And may I know the time limit?
[AGENT][NEUTRAL] For additional um information, there's no fi limit. Once we receive it, we'll continue processing.
[CUSTOMER][NEUTRAL] Thank you. And resubmit, when resubmitting it, it is required to send the claim form with the primary UB or just the UB is enough?
[AGENT][NEUTRAL] Um, that's up to your preference, either or, we'll process it as soon as we receive it.
[CUSTOMER][POSITIVE] All right. Thank you so much. And
[CUSTOMER][POSITIVE] That's it. Thank you so much for your assistance. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL. Have a good day. Bye bye.
[CUSTOMER][POSITIVE] You too. Thank you.