AccountId: 011433970860
ContactId: 37b7c222-b878-47ce-b7bd-12f9a994ee17
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 779349 ms
Total Talk Time (AGENT): 199754 ms
Total Talk Time (CUSTOMER): 285390 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/37b7c222-b878-47ce-b7bd-12f9a994ee17_20250115T18:53_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from the provider's office name urgent care. I always called us Williams Group Medical Practice.
[AGENT][NEUTRAL] OK, and how may I assist you today, [PII]?
[CUSTOMER][NEUTRAL] Uh, actually, I just want to know on claim status that you have submitted on [PII] through a PayPal claim on the mailing address is [PII]. Is the correct mailing address?
[AGENT][NEUTRAL] It depends on the type of policy. I'll have to take a look. So you're calling for claim status?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Just give me a second, I'll check, check on it.
[CUSTOMER][NEUTRAL] Mm, I just say it's.
[CUSTOMER][NEUTRAL] Just 12, just only 1.
[AGENT][NEUTRAL] OK, and may I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] Uh, the, the callback number is [PII] direct line.
[CUSTOMER][NEUTRAL] I.
[AGENT][POSITIVE] Thank you for that and then the policy number when you're ready.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Sorry, can you repeat?
[AGENT][NEUTRAL] The member's policy number when you're ready.
[CUSTOMER][NEUTRAL] Yeah, just give me a minute.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, please, please make a note of it. It's 0215625.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] Looks like it's missing a number 0215.
[AGENT][NEUTRAL] Looks like it's missing a number 0215625.
[CUSTOMER][NEUTRAL] 45.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So 215-625-45?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEGATIVE] OK, can you say the policy number altogether because that's not right, that's not correct. It's giving me an error.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I repeat the number. It's 02156245.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Can you verify the member's first and last name and date of birth? It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payments.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] And the total
[CUSTOMER][NEUTRAL] It's $167 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] And what is
[CUSTOMER][NEUTRAL] It's, uh just give me a minute. Can you repeat the question what you're asking? Can you repeat the questions?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, the facility name?
[CUSTOMER][NEUTRAL] It's William Medical Group Practice.
[AGENT][NEUTRAL] Could it be under any other name?
[CUSTOMER][NEUTRAL] Express urgent care.
[AGENT][NEUTRAL] OK, that's it. Hold on one moment.
[CUSTOMER][NEUTRAL] OK then
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] So I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] Just.
[AGENT][NEUTRAL] The claim number
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah. Uh you on?
[AGENT][NEUTRAL] [PII], well, it was received on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 354.
[AGENT][NEUTRAL] 1184.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim $50.
[CUSTOMER][NEUTRAL] Just hold on.
[CUSTOMER][NEUTRAL] I repeat the claim number, it's 3541184. Am I correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Did you need the check information?
[CUSTOMER][NEUTRAL] Did you need the check information? Yeah, please give me the check number.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] The check number is 201.
[CUSTOMER][NEUTRAL] The number is 201201.
[AGENT][NEUTRAL] 856 8.
[CUSTOMER][NEUTRAL] 85 856 8
[AGENT][NEUTRAL] Um, it was issued on [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Am I right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Is that correct? Yeah. And it was sent to.
[AGENT][NEUTRAL] And it was sent to [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Just a minute.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'll do check it, check number is 2018568. and the check issued on [PII], sorry, I'm sorry, [PII], right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Can you tell for which mailing you have sent this uh check?
[AGENT][NEUTRAL] So the
[AGENT][NEUTRAL] OK, hold on one moment. Let me go back to that.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] The the check was sent to [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] If the check has not been received by end of day tomorrow, um, you can give us a call on the [PII] and we can check on the check and reissue it if need be, um, but we have to wait 30 days, a full 30 days.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Fine.
[CUSTOMER][NEUTRAL] Just, just uh give me a moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] All right, that's it for the day, I think.
[CUSTOMER][NEUTRAL] And just, and just to hold on for a minute. I do have to see another claim for working under the same category. Could you hold on for a minute?
[AGENT][NEUTRAL] All [PII]. Well,
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Yeah. Thank you for your patience.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Just a minute.
[CUSTOMER][NEUTRAL] Uh, thank you for your patience, [PII]. And I do see the, uh, and one claim has been also sent to your mailing mailing address. It's
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Is it for the same member?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] No, I, it's a
[AGENT][NEUTRAL] Oh, you're speaking of
[CUSTOMER][NEUTRAL] No, no, so not for the same number.
[AGENT][NEUTRAL] OK, so this is a new claim that you're speaking of?
[CUSTOMER][NEUTRAL] Yeah, it's a new la.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] Uh just give me a minute.
[CUSTOMER][NEUTRAL] It's 1905619.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total bill value is $629 even.
[AGENT][NEUTRAL] Thank you for that. And again, all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment while I locate the claim.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] And would this be the same provider or a different provider on file?
[AGENT][NEUTRAL] Would this be the same provider as the other claim or a different provider?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, same provider.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[CUSTOMER][POSITIVE] Yeah, saved.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The claim number is 3541182.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 34.
[CUSTOMER][NEUTRAL] 3541182
[AGENT][NEUTRAL] Mhm. And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] Oh, could you repeat the denied date is?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] Just me
[CUSTOMER][NEUTRAL] Fine.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] The reason is the limit has been met by the patient. The outpatient visit limit has been met by the patient, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, OK. Uh, I think that's it for today. Can I get a claim uh call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And was there anything else I could assist you with today, [PII]?
[CUSTOMER][POSITIVE] Um, yeah, I think that's it for today. Thank you for [PII]. Have a wonderful day.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.