AccountId: 011433970860
ContactId: 33a0f5d2-e929-4b96-b71e-d53eb9ce3671
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 338359 ms
Total Talk Time (AGENT): 119738 ms
Total Talk Time (CUSTOMER): 222119 ms
Interruptions: 10
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/33a0f5d2-e929-4b96-b71e-d53eb9ce3671_20250213T21:13_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office to check on the claim status.
[AGENT][NEUTRAL] OK, I can verify claim status for you. And you say your name is [PII]?
[CUSTOMER][POSITIVE] Yeah, that's right.
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] OK, and what is that policy number, please?
[CUSTOMER][NEUTRAL] It's D as in Delta 41203335.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, it's not one of our policy numbers. Do you have the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] official name is [PII].
[AGENT][NEUTRAL] I'm sorry, what's that name again? Uh spell the first and last name for me, please.
[CUSTOMER][NEUTRAL] First name is [PII].
[CUSTOMER][NEUTRAL] Second name is [PII].
[AGENT][NEUTRAL] OK, date of birth.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] I'm like wow.
[AGENT][NEUTRAL] OK, and you say you're calling for claim status for her, correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, um, first, do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] It's [PII]. It's a direct line.
[AGENT][NEUTRAL] OK, and verify the uh the date of service and the amount of the charge.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] They of services.
[CUSTOMER][NEUTRAL] [PII], total charge amount is $947 even.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] And you're calling from?
[CUSTOMER][NEUTRAL] Community Medical Associates.
[AGENT][NEUTRAL] OK, and while I'm looking at claim information, let you know we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII].
[AGENT][NEUTRAL] And I show this claim processes, our records indicate that premium for the service was not received, therefore benefits are not payable. So essentially the patient was not eligible for the data service.
[CUSTOMER][NEUTRAL] about
[CUSTOMER][NEUTRAL] May I know the receive and process it?
[AGENT][NEUTRAL] Sure. Give me one moment.
[CUSTOMER][NEUTRAL] The.
[AGENT][NEUTRAL] Uh, I show this claim was received on [PII], processed on [PII].
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] [PII] and process of [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You state that the member is not eligible.
[CUSTOMER][NEUTRAL] What data of service.
[AGENT][POSITIVE] For the data service. Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, OK. May I know the effective and term rate for this number?
[CUSTOMER][NEUTRAL] I mean, I mean yeah.
[AGENT][NEUTRAL] Uh, policy effective date is [PII], and I show the policy is active.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So it's still active, right? OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] remember.
[AGENT][NEUTRAL] OK, and [PII], is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] This member has any other active policy, any second rate.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Not for, uh, with our uh company.
[CUSTOMER][NEUTRAL] My.
[CUSTOMER][NEUTRAL] Oh, so member doesn't have any other active policy, right?
[AGENT][NEUTRAL] Not any active medical policies with our company.
[CUSTOMER][NEUTRAL] OK, could you please fax me the EOB.
[CUSTOMER][NEUTRAL] Also, I have one more question. Is the remaining balance is totally a member responsibility?
[AGENT][NEUTRAL] We can't give patient responsibility. We can only verify how the claim was processed. One.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, could you please fax me to you.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah, before that, could you please spell me your name?
[AGENT][NEUTRAL] [PII] last initial [PII]
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and what is the fax number?
[CUSTOMER][NEUTRAL] Fax number is [PII].
[AGENT][POSITIVE] OK, thank you. And I'll fax this over. Is there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] And I ask that you know.
[CUSTOMER][POSITIVE] Thank you so much. May I have the reference number?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. If you like, you may use my name in today's date.
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][POSITIVE] Thank you so much. Have a nice day.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Bye.
[CUSTOMER][NEUTRAL] Let me