AccountId: 011433970860
ContactId: 39f82019-cbe3-45ba-bc12-6ef5b20a11bf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 478299 ms
Total Talk Time (AGENT): 178571 ms
Total Talk Time (CUSTOMER): 147100 ms
Interruptions: 5
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/39f82019-cbe3-45ba-bc12-6ef5b20a11bf_20250522T15:04_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. My name is [PII] and I'm looking for a claim status calling from provider's office.
[AGENT][NEUTRAL] OK. Can you spell your name for me, please?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, [PII]. Thank you. And you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that, [PII]. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the members call do you just have one how many claims they do you have?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] One.
[AGENT][NEUTRAL] OK. And what is that member's policy number?
[CUSTOMER][NEUTRAL] Just a second please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Member policy number is 022.
[CUSTOMER][NEUTRAL] 80
[CUSTOMER][NEUTRAL] 963.
[AGENT][NEUTRAL] 963. Is that correct?
[CUSTOMER][NEUTRAL] Yes. Yes.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] And the any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Welcome.
[AGENT][NEUTRAL] And the date of service and total bill amount please.
[CUSTOMER][NEUTRAL] [PII] and the bill amount is
[CUSTOMER][NEUTRAL] $482 even.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Mm yeah.
[CUSTOMER][NEUTRAL] Exactly how to.
[AGENT][NEUTRAL] OK, this claim was received on 228-24.
[AGENT][NEUTRAL] It was processed and denied on 31-2024.
[AGENT][NEUTRAL] The claim number is 342-5552.
[CUSTOMER][NEGATIVE] Uh, denied for.
[AGENT][NEUTRAL] Um, yes, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] The reason for the denial states outpatient benefit for this calendar year has been met.
[CUSTOMER][NEUTRAL] OK, like the benefits for, uh, you are.
[CUSTOMER][NEUTRAL] Oh, right.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Can you fax me the please?
[AGENT][NEUTRAL] Yes, but you can also print it yourself by going to our portal at [PII].
[AGENT][NEUTRAL] Now that you have the claim number.
[CUSTOMER][POSITIVE] Secure.
[AGENT][NEUTRAL] Uh-huh. [PII].
[CUSTOMER][NEUTRAL] [PII]. Can you, can you stay online just know I'm able to.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] It's like S E C U R E. A.
[AGENT][POSITIVE] No, you need to put a D on the word secure. It's secured.
[CUSTOMER][NEUTRAL] B
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] But I will fax this one to you. So one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's, it's not
[CUSTOMER][NEUTRAL] We need to register first, right?
[AGENT][NEUTRAL] Yes, it's a self-registering portal, you would just follow the steps and answering the questions to set up your profile.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this information is still loading.
[AGENT][NEUTRAL] Will it need to be sent to your attention, Dee, or is that not necessary?
[CUSTOMER][NEUTRAL] And uh no, you can put it attention.
[AGENT][NEUTRAL] Attention day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And can you suggest what we need to put in patient account number?
[AGENT][NEUTRAL] The patient account number is the account number that you all have for the member in the system under the provider, it's not their APL policy number.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEGATIVE] It's not showing up with the patient account number.
[AGENT][NEUTRAL] And what is the account number in your system? Give me just a moment to get back to that screen. What a patient account number are you using?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, so there's a letter in front of the one and there's a couple of additional numbers after the last one.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK. Is it, is it H?
[AGENT][NEUTRAL] On the claim that we received.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] The number in the front alphabetic is in the front is [PII]
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And may have, OK, let me check, OK.
[AGENT][NEUTRAL] Go ahead and give me your fax number.
[CUSTOMER][NEUTRAL] Yes, that's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And did you say the area code was [PII]? Is that correct?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it is the member responsibility right like the members benefits.
[AGENT][NEUTRAL] We do not determine we do not determine patient responsibility. That would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. May I call the number, please?
[AGENT][NEUTRAL] Yes, you would use my name along with today's date.
[AGENT][NEUTRAL] And I have faxed that EOB to you also.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] Yes. Yeah, I mean that that like how much time it will take for the fax.
[AGENT][NEUTRAL] It has been sent, so I'm not sure. You should be receiving it very shortly, probably within 30 minutes.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're very welcome. And again, do you is there anything else? Yeah, you too. Can I help you with anything else at first?
[CUSTOMER][POSITIVE] Thank you, [PII]. Have a good day. Thank you.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] OK. Well, thank you again for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] Contact.
[CUSTOMER][POSITIVE] Alright, thank you.