AccountId: 011433970860
ContactId: 3a443952-1a15-45dd-ab55-b9567ceefab2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 492019 ms
Total Talk Time (AGENT): 189652 ms
Total Talk Time (CUSTOMER): 171356 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/3a443952-1a15-45dd-ab55-b9567ceefab2_20250211T17:06_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Did you say [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Oh hey um I was just transferred over to you from um 90 Degree um evidently you guys are the ones that handle claims for this patient, but um I do not have their APL ID number and she said you could pull them up by name and date of birth.
[AGENT][NEUTRAL] OK, uh, what is your name first? I'm sorry.
[CUSTOMER][NEUTRAL] It's OK. It's [PII] [PII].
[AGENT][NEUTRAL] I don't know why my brain went to tea. Anyway, um, and what's that patient's name, Ms. [PII]?
[CUSTOMER][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] And birth date is [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and it's direct.
[AGENT][POSITIVE] OK, thank you, Miss [PII]. Give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And what state is he from?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Oh see.
[CUSTOMER][NEUTRAL] I don't have a card on file at all for um evidently the 90 degree they just handle preventive care.
[CUSTOMER][NEUTRAL] Claims
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] And so you're calling to verify claim status for?
[CUSTOMER][NEUTRAL] Yes, I doubt, I doubt that you're gonna have these on file because.
[CUSTOMER][NEUTRAL] It looks like they went to.
[CUSTOMER][NEUTRAL] It says benefit in a card DIC [PII] unless the claims are forwarded to you.
[AGENT][NEUTRAL] Well, usually when claims are sent to that address, they will go to both 90 Degree and to APL, um, but what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh perfect. OK, uh, I have two for [PII].
[CUSTOMER][NEUTRAL] The first bill amount is for $1178.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the second one is for $68.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then I have one for [PII].
[CUSTOMER][NEUTRAL] For $17.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEGATIVE] Why can't they just make it simple, just have one carrier?
[AGENT][POSITIVE] That would be nice, wouldn't it?
[CUSTOMER][NEUTRAL] That would be way too easy is that.
[AGENT][NEUTRAL] Just wanna keep you on your toes, I guess.
[CUSTOMER][NEUTRAL] I guess.
[CUSTOMER][NEUTRAL] Job security, I guess.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 3643 and see.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] I said 36453.
[AGENT][NEUTRAL] Um, we have received the claim, both claims for [PII].
[AGENT][NEUTRAL] And both um the claims process is not covered diagnostic tests on the plan, and as far as the one for [PII], we had not received that claim, but the patient's policy termed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, hold up, hold up.
[CUSTOMER][POSITIVE] So it charmed on what?
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] OK, and do you, do you have a from date for me?
[AGENT][NEUTRAL] Um, it was effective [PII].
[CUSTOMER][NEUTRAL] [PII] till then, OK.
[CUSTOMER][NEUTRAL] OK, well, we know the [PII]'s not covered.
[AGENT][NEUTRAL] Yes, ma'am, but
[CUSTOMER][NEUTRAL] So the other two, what's going on with the other two now?
[AGENT][NEUTRAL] Uh, the other two process or not, uh, process is not a covered diagnostic test.
[CUSTOMER][NEUTRAL] OK, so this is, this was an echo for cardiology.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, it's not covered. Under the insurance policy with us, they had a diagnostic benefit. They were only covered for MRI, CT or colonoscopy.
[CUSTOMER][NEUTRAL] MRI CT or a colonoscopy.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so neither one of those are covered.
[AGENT][POSITIVE] Correct, yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, is there, since I don't have access to the EOBs, is there any way I could get access to those?
[AGENT][NEUTRAL] I can uh fax them to you.
[CUSTOMER][NEUTRAL] OK, are they on, are they on the APL portal?
[AGENT][NEUTRAL] Uh, they should be on the online service center, yes, ma'am. And if you like, I can give you those two claim numbers would be a quicker, um, way to find them.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'll, I'll take the fax too. I'll take the fax too just in case I can't find them. And what's the claim number on the phone?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, the one for 178, it's 3503643.
[AGENT][NEUTRAL] And the other first.
[CUSTOMER][NEUTRAL] OK, and that was
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] When was it received?
[AGENT][NEUTRAL] Uh, let me go and see this one received on.
[AGENT][NEUTRAL] Um, received on [PII], processed on [PII].
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] And the other, um, and the second one for the $68 that one also received on the [PII] processed on the [PII], and it's 3503633.
[CUSTOMER][NEUTRAL] OK, and the second one?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's your fax number, Ms. [PII]?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, that's [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] OK, I will fax these over to you in a few moments. Um, is there anything else I can assist you with? I'm sorry.
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] No, no, you're fine. Do you have a um call reference number or is it just your name and today's date?
[AGENT][NEUTRAL] Uh, you can use my name at today's date.
[CUSTOMER][NEUTRAL] OK, and your initial?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sure you're the only [PII] there, right?
[AGENT][NEUTRAL] I am.
[AGENT][MIXED] It's kind of [PII], but it's OK.
[CUSTOMER][NEUTRAL] That's all right. All right, um, well thank you very much and how long should I expect for those faxes? Just a few minutes or?
[AGENT][NEUTRAL] Uh, yes, ma'am. Just a few minutes. I'm making sure that I can find them, uh.
[AGENT][MIXED] Why is my because my computer doesn't like me today, but that's fine.
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] OK, I will send these off to you in a few moments.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I give it about 5 minutes. Yes, ma'am.
[CUSTOMER][POSITIVE] All right, well thank you.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] You have a good day.
[AGENT][POSITIVE] Alright, you too, and thank you for calling APL.
[CUSTOMER][NEUTRAL] Uh-huh, bye bye.
[AGENT][NEUTRAL] Bye.