AccountId: 011433970860
ContactId: 3a8284ee-7708-41ac-8227-5950131ec04c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1116680 ms
Total Talk Time (AGENT): 338266 ms
Total Talk Time (CUSTOMER): 281204 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/3a8284ee-7708-41ac-8227-5950131ec04c_20250617T15:22_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Oh hi [PII], my name is [PII] and I'm calling from Blessing Hospital. I'm checking for a claim status for this member.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim status, [PII]. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Um, callback number, it's gonna be [PII]. Direct line of extension.
[AGENT][NEUTRAL] Thank you. May I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure. Uh, member policy number that we have on the file, um, it's going to be um 02138628.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. It's for um [PII]. Date of birth of [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 and the total bill for the claim?
[CUSTOMER][NEUTRAL] Sure. It's [PII]. The total bills in our claim, it's going to be um $12,826.28.
[AGENT][NEUTRAL] OK, [PII] $12,826.28 for [PII].
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Sure, that will be fine.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm. You are on hold.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] 382079.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] I can focus.
[AGENT][NEUTRAL] 32.
[AGENT][NEUTRAL] 862-1. What's the first?
[AGENT][NEUTRAL] 347.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes, I'm still here.
[AGENT][POSITIVE] All right, thank you so much for holding. I apologize for the wait. And can you verify the name of the provider's office on the claim?
[CUSTOMER][POSITIVE] Um, it's a blessing Hospital.
[AGENT][NEUTRAL] Alright, so I'm showing that the claim was received, uh, it keeps switching. I'm sorry.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] Claim number is 34.
[CUSTOMER][NEUTRAL] Oh, uh-huh.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Oh, I do apologize for that. Um, because we recently submitted the copy of claim on [PII]. You mentioned that it was received on July. Is that correct?
[AGENT][NEUTRAL] Yes, you said the date of service was [PII], right?
[CUSTOMER][NEUTRAL] Uh yes. The data services may, however, that based on what I'm showing on our end.
[AGENT][NEUTRAL] OK, so the
[CUSTOMER][NEUTRAL] Uh-huh. Go ahead, I'm sorry.
[AGENT][POSITIVE] Thank you. So, we received this claim with your total bill.
[AGENT][NEUTRAL] I can double check it if you like. Hold on one moment.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] But this claim was received on [PII], this is the very first time.
[AGENT][NEUTRAL] We received it. We received it again.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, hold on one moment, I'm going between the claims. In [PII], but that was denied as a duplicate of the original claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] So, would you like the original claim status?
[CUSTOMER][NEUTRAL] Um, yes, please. Mhm.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So we received the claim on [PII].
[AGENT][NEUTRAL] Claim number is 347.
[AGENT][NEUTRAL] 862 1.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the calendar year max for the accident and sickness benefit has been met.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] [PII] so.
[CUSTOMER][NEUTRAL] It seems to verify if this um information are available to your web portal. Do you have a web portal?
[AGENT][NEUTRAL] Yes, our online service center, yes, you can check claim status on there.
[CUSTOMER][NEUTRAL] Uh, may I know your web portal name?
[AGENT][NEUTRAL] Yes, so you will go to [PII].
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And once the page populates, you'll click on sign in.
[AGENT][NEUTRAL] And create your um account as a provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got it. Thank you for that information.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEUTRAL] All right. Uh, oh, by the way, um, like what I mentioned earlier that, um, we recently submitted a copy of claim on [PII]. By any chance, do you receive any copy of claim for that date?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, let me see if these other claims are, it doesn't have the same total bill, but hold on one moment.
[AGENT][NEUTRAL] 538.
[AGENT][NEUTRAL] But with the same data service, correct?
[CUSTOMER][NEUTRAL] Yes, it's gonna be the same date of service.
[AGENT][NEUTRAL] So, no, um, the other claims that came in for the same date of service, um, they were all received on [PII].
[AGENT][NEUTRAL] We haven't
[CUSTOMER][NEUTRAL] I see.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] I, I think I'm all good for this one,
[AGENT][NEUTRAL] We do have things from March, we do have things for [PII] from Blessing Hospital, but it's a different data service than your claim.
[CUSTOMER][NEUTRAL] Uh-huh, go ahead.
[CUSTOMER][NEUTRAL] Um, hold. Mm, I see. By any chance, um, because I have here another date of service for the same member, by any chance, can you take a look for this one also?
[AGENT][POSITIVE] Yes, you can give me all the dates of service.
[CUSTOMER][NEUTRAL] Oh, date of service of [PII].
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] Um, total bill is 30, I'm sorry, no, it's gonna be $6,451.74.
[AGENT][NEUTRAL] Do you have any other dates of service?
[CUSTOMER][NEUTRAL] Um, I do. And the next one,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] If um data service of
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] build
[CUSTOMER][NEUTRAL] Yes. And the bill amount is $5,339.37.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, any others?
[CUSTOMER][NEUTRAL] And that is all.
[AGENT][NEUTRAL] OK. Do you mind if I place you on just a brief hold so I can look through the dates?
[CUSTOMER][POSITIVE] Sure, that's all fine. Thank, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes, I'm still here.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for the wait. So for date of service, [PII], so I'll do it like this. Both of the claims were received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, both of the claims were processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The [PII] claim number is 357724-4.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] is 357-7234.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And they both were denied for the same reason?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] The calendar year max for outpatient sickness and accident treatment in the emergency room has been met.
[CUSTOMER][NEUTRAL] Calendar year.
[AGENT][NEUTRAL] Max has been met.
[CUSTOMER][NEUTRAL] has been met
[CUSTOMER][NEUTRAL] Calendar year has been max.
[AGENT][NEUTRAL] The calendar year max has been met.
[CUSTOMER][NEUTRAL] Oh, I see. Um, I just want to verify for how many visits are the member have per calendar year.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] All right, so for the emergency room, the policy will pay up to $1000.01 time per calendar year.
[CUSTOMER][NEUTRAL] Calendar year.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] All right then. I think I'm all good for this one, just a reference number. I just want to verify if you have um a web or an email care team at
[CUSTOMER][NEUTRAL] [PII]. They have a
[AGENT][NEUTRAL] Yes, that is our email.
[CUSTOMER][NEUTRAL] Something like that.
[CUSTOMER][NEUTRAL] And we can also send that um email inquiry to get the claim status information.
[AGENT][NEUTRAL] No, um, so email, no, so.
[AGENT][NEUTRAL] Your claim statuses are through our online portal, which I um I showed you how to get to from sign in. So once you create your account as a provider, you would go to the online portal into the patient account number, and I think it asks for other information and then um you can check your claim status is on the portal. Email is different.
[CUSTOMER][NEUTRAL] Oh, I see.
[CUSTOMER][NEUTRAL] Because I'm trying to create a web portal, however, that our tax ID is not been um.
[CUSTOMER][NEGATIVE] Not valid, that is still, that is not valid.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, and what is the tax ID number that you're providing?
[CUSTOMER][NEUTRAL] Um, tax ID number [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Um, I, so I'm not sure what's being entered on your side. Um, it's letting me complete the account set up. So I would try to um enter that tax ID again, um, and then it should let you go to the next steps because I'm able to get to the next step on my end.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I click the provider.
[CUSTOMER][NEUTRAL] And I click next, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yes, that is the one that I'm clicking. And I um I provide the 370661183.
[CUSTOMER][NEGATIVE] I click next and it is stated that no user was found with the information that was entered. Please try again. If the error persists, please contact the customer service.
[AGENT][NEUTRAL] OK, you
[AGENT][NEUTRAL] All right, you might need to clear your, um, your browser history on your browser.
[AGENT][POSITIVE] Because I'm entering it on my end and it's not giving me any issues, um, so I.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The only thing I can say is to clear the browser and see if that will clear out whatever is on the, you know, whatever is blocking and hopefully it'll work then.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Oh, all right. All right. I'm gonna try that, um, er, um, later. And all right, so I think I'm all good for this one. Just a reference number for our call, I think I'm all good.
[AGENT][NEUTRAL] Alright, so there's no call reference number, but you can use my name in today's date. And again, that's [PII] The first initial of my last name is [PII].
[CUSTOMER][POSITIVE] Alright, perfect, thank you for assisting [PII]. Have a nice and always stay safe, OK? Bye for now.
[AGENT][POSITIVE] You also, and thanks for calling APL. Was there anything else I can help with?
[CUSTOMER][POSITIVE] I think I'm all good for that. Thank you for those information you provide to me, and I really appreciate it.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Alright, have a good day and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] All right. You too, bye bye.