AccountId: 011433970860
ContactId: 38d08daf-835d-4ca4-b4c3-8bb02f8eb5a7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 373109 ms
Total Talk Time (AGENT): 163465 ms
Total Talk Time (CUSTOMER): 143317 ms
Interruptions: 6
Overall Sentiment: AGENT=1.2, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/38d08daf-835d-4ca4-b4c3-8bb02f8eb5a7_20250311T12:53_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi Miss [PII], how are you? I've had a whole conversation on mute. I'm sorry.
[CUSTOMER][NEUTRAL] My name is [PII]. My name is [PII], and I'm calling from Lexington Medical. Just trying to see if you could assist with claim status.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status?
[CUSTOMER][NEUTRAL] Your portal
[CUSTOMER][NEUTRAL] Yes ma'am, well I need to know if you have it because your portal is saying it's not found so.
[AGENT][POSITIVE] Oh yes ma'am I can help you with claim status. Sure I can you're welcome and what is a good call back number for you please?
[CUSTOMER][POSITIVE] Let's see if that is correct, thank you.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 01972971
[AGENT][NEUTRAL] OK thank you one moment please while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Oh, you're fine.
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you and the date of uh service and total bill amount for him, please.
[CUSTOMER][NEUTRAL] It's [PII]. Total bill amount is $324 but it looks like it looks like the balance is $75 that's out to you all.
[AGENT][NEUTRAL] OK, so the total that was 324.
[CUSTOMER][POSITIVE] Yes ma'am, that's correct.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, [PII], let's see.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] So we did receive that claim. It was received on 7-5-2024.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was processed on 7-10-2024.
[AGENT][NEUTRAL] The claim number was or is 34,790 uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 347.
[CUSTOMER][POSITIVE] OK, I'm with you 347-90 yes ma'am.
[AGENT][NEUTRAL] Did you get
[AGENT][NEUTRAL] 10.
[CUSTOMER][NEUTRAL] 10 OK.
[AGENT][NEUTRAL] And this claim was denied and the reason for the denial on here is that office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] Mm, OK, is there any way that you could send an EOB to me or?
[AGENT][NEUTRAL] Yes, ma'am. Can you try? are you logged into the portal where you could try and see with the claim number if you're able to access it? For some reason, sometimes without, without that, you do have some difficulty. I'm not sure what the answer is for that.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It does.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, well let me try while I have you on the line. Yeah, let me try while I have you on 347-9010 is the claim number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] But then people have the claim number and they can pull it up with.
[AGENT][NEUTRAL] You know, without any difficulty, so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, that'll be great, let's see here.
[AGENT][NEUTRAL] 347-901-0.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Happy Tuesday for me. Let's see, can I pull the EOB? Yeah, I'm trying to see if the EOB is gonna come up. Um, it's the start and download is it, so.
[AGENT][NEUTRAL] Were you able to get it?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, sure. Yeah, let's make sure you can access it.
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] Yeah, let's see if this is it.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] Yes ma'am, thank you so very much I do appreciate that so this the claim that number that matters.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I mean, and it, you know, if you have all of the other other other information, you know, cause it gives you three different options, you know, really, again, I'm not sure why people have trouble, you know, doing that. Obviously, I'm not in IT.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh yeah, you know, yes, yes, yes, I understand that.
[AGENT][NEUTRAL] So I, I
[AGENT][NEUTRAL] If it, you know, but, um, but with the claim number, they typically can find it OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, alright, thank you, Ms. [PII] do you have a reference number for our call today?
[AGENT][NEUTRAL] Sure, you would use my name [PII] along with today's date.
[CUSTOMER][NEUTRAL] OK, you I or Y or I E I, OK, OK.
[AGENT][NEUTRAL] I, I, your first one, and that's never the first one usually. That's never the no, it's usually Y E Y or IE and I'm like, hm.
[CUSTOMER][NEUTRAL] Really?
[CUSTOMER][NEUTRAL] I had a
[CUSTOMER][NEUTRAL] Oh, I forgot about the EY yeah.
[AGENT][POSITIVE] Yeah, so, but, well, you're welcome, [PII] and is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Thank you, Ms. [PII].
[CUSTOMER][POSITIVE] That's it thank you I do appreciate your time alright you have a great day.
[AGENT][POSITIVE] OK. Well, you're certainly welcome. I hope you have a great day too, and thank you again for calling APL. Yes, ma'am.
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][POSITIVE] Yes ma'am, take care bye bye.
[AGENT][NEUTRAL] You too. Bye bye.