AccountId: 011433970860
ContactId: 3f1dc961-fccc-4143-9339-d05d41ab509b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 586859 ms
Total Talk Time (AGENT): 214189 ms
Total Talk Time (CUSTOMER): 227664 ms
Interruptions: 8
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/3f1dc961-fccc-4143-9339-d05d41ab509b_20250128T17:01_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] Hi [PII], myself, uh, [PII]. I'm from provider's office. I'm here to check the claim status, [PII].
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status and for my notes, can you spell your first name for me please and provide a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, my first name is [PII]. It's [PII] and last name initial is [PII].
[CUSTOMER][NEUTRAL] And my contact number is [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you for that. And [PII], how many claims do you have in total today?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Uh, I'd have two claims.
[AGENT][NEUTRAL] OK, may I have the first member's policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 1360083.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, member's first name is [PII] and last name is [PII], and 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. May I have the date of service for the claim you like me to check on?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah, data service it's uh it's [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] Yeah, charge amount is $449.79.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, the office is, uh, it's Advantage Family Care INC.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] So we only have
[AGENT][NEUTRAL] One claim here for that data service, it is from your provider, but it's a different total bill. It's showing a total bill of 298.78 versus the 44979. Could this be the same claim?
[CUSTOMER][NEUTRAL] But it's.
[CUSTOMER][NEUTRAL] 440.
[CUSTOMER][NEUTRAL] I don't know that, uh, can I have the uh claim uh the date of service is uh [PII] or some other date?
[AGENT][NEUTRAL] [PII]. What are the what are the procedure codes on the claim you're looking for?
[CUSTOMER][NEUTRAL] Uh yeah, it's uh 99213 and 99051 and 87811 and 87804A and 87804B and uh 99213.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] A L
[AGENT][NEUTRAL] OK, so we only have one claim and it does include codes 9921399051 and then 878.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] 04, but those are the only codes. So,
[CUSTOMER][NEUTRAL] 04
[AGENT][NEUTRAL] Would you like this claim status or is this, are you looking for another claim?
[CUSTOMER][NEUTRAL] Claims or
[CUSTOMER][NEUTRAL] Is are you looking for another claim?
[AGENT][NEUTRAL] Because if so, the other claim is not on file.
[CUSTOMER][NEUTRAL] 00, not on 5.
[CUSTOMER][NEUTRAL] But how much the charge amount, uh,
[CUSTOMER][NEUTRAL] You have said uh something uh 200.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] The total bill for the claim that we have on file is 298.78.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. OK. Can I have the claim receive date?
[AGENT][NEUTRAL] Um, just to be on the safe side, what is your um, your tax ID?
[CUSTOMER][NEUTRAL] Yeah, sure, um.
[CUSTOMER][NEUTRAL] Tax ID is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, yeah, it's the same tax ID. So we received the claim on [PII].
[CUSTOMER][NEUTRAL] OK, and processed.
[AGENT][NEUTRAL] Claim number is
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Sorry, can I have the process date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, claim number.
[AGENT][NEUTRAL] 352-727-0
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim was denied because the services were rendered after coverage was terminated.
[CUSTOMER][NEGATIVE] I just don't want.
[CUSTOMER][NEUTRAL] After coverage terminated.
[AGENT][NEUTRAL] Correct. So this policy was active from [PII].
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] After [PII], there were no other active policies with APL.
[CUSTOMER][NEUTRAL] Oh, after [PII], uh, there's no proactive policy for the member.
[AGENT][NEUTRAL] With APL, correct.
[CUSTOMER][NEUTRAL] OK. Do you have any other active insurance during the date of service?
[CUSTOMER][NEUTRAL] Could you check that one.
[AGENT][NEUTRAL] No, not with APL.
[CUSTOMER][NEUTRAL] OK. And uh could you please spell?
[AGENT][NEUTRAL] If there is another insurance, go ahead.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, yeah, carry on, carry on. You have said something, yeah.
[AGENT][NEUTRAL] If there is another insurance, you will have to reach out to the member, um, because we don't have, we don't have it on file.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][POSITIVE] OK. Thank you so much. Uh, could you please spell your name?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, [PII], can I have the call reference number, [PII]?
[AGENT][NEUTRAL] Sure, so for the entire call, the call reference will be my name and today's date.
[CUSTOMER][NEUTRAL] OK, [PII], just a moment.
[CUSTOMER][POSITIVE] OK, thank you so much and just a moment and I'll borrow the next one just a second.
[AGENT][NEUTRAL] Um, hold on one moment, let me just note this policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yeah take your time, uh then.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah, the next policy number is uh it's 1[PII].
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] Is that a social?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, that's the that's the policy number.
[AGENT][NEUTRAL] Do you have a copy of their member ID card?
[CUSTOMER][NEUTRAL] Oh, just a moment.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh, I don't have the, uh, member ID card.
[AGENT][NEUTRAL] OK, because the APL policy number is about 7 to 8 digits. Um it'll have that ML 7 or 8 at the end.
[CUSTOMER][NEUTRAL] I'm.
[AGENT][NEUTRAL] Um, this might be their primary, uh, policy number, but this is too many numbers for APL. Do you have a social or I can try to look with the first and last name?
[CUSTOMER][NEGATIVE] Oh, but this is too many numbers.
[CUSTOMER][NEUTRAL] Yeah, could you please verify the first name and last name, uh, because I don't have the social.
[AGENT][NEUTRAL] OK, what's the first and last name?
[CUSTOMER][NEUTRAL] Yeah, yeah, member's first name is [PII].
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Her last name is [PII]. It's [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the policy's just populated. I'm looking for uh his now.
[CUSTOMER][NEUTRAL] It's populated. I'm looking for.
[AGENT][NEUTRAL] OK, so I'm actually not showing a policy on file for [PII].
[CUSTOMER][NEGATIVE] Actually no.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, we're gonna need more information to file to um search for this. Do you have a claim number?
[CUSTOMER][NEUTRAL] Yeah, we're gonna need more information to file to um search for this. Do you have a claim number? Oh no, I don't have the claim number.
[AGENT][NEUTRAL] OK, um, well, we would need more information on this, this one. we can search with the social. Nothing came up with the first and last name, um, and that policy number is not an APL policy number.
[CUSTOMER][NEGATIVE] I won't.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] We can search with the social. Nothing came up with the first and last name.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] A policy.
[CUSTOMER][POSITIVE] OK, that's fine. OK. Thank you so much. Thanks for the information. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. You also.
[CUSTOMER][NEUTRAL] APL you
[AGENT][NEUTRAL] Bye bye