AccountId: 011433970860
ContactId: 412d1dea-6636-4281-ac4f-6a563780ebbd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 376519 ms
Total Talk Time (AGENT): 172176 ms
Total Talk Time (CUSTOMER): 115146 ms
Interruptions: 4
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/412d1dea-6636-4281-ac4f-6a563780ebbd_20250521T14:31_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. My name's [PII]. I'm calling to check on the status of a claim.
[AGENT][NEUTRAL] OK, [PII], so you have one claim that you're needing to check status on, is that correct? Yes, ma'am, I can help you. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I have a direct line of [PII].
[AGENT][NEUTRAL] Thank you. And then what is the member's policy number, please?
[CUSTOMER][NEUTRAL] I have 25, I'm sorry, 0253821, M as in Mary, L as in Larry, and the number 8.
[AGENT][NEUTRAL] OK, so we're missing a number there. Do you have an ID card?
[CUSTOMER][NEUTRAL] Uh, let me see.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Because you gave me the first part of the number you said was 0253821?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] But that's we're missing a number.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, let me see what I have like.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] I think they did oh I have the back of the card. Let me see. I look at my file.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] On the front, there should be an in-hospital and an outpatient number based on the number you gave me that you were just missing a digit and what you called off to me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, it's the 5 before the M.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so there's a 5 after the number 1.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, all right, just one moment please.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and the information that I do provide, [PII] 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] OK.
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] It's [PII] for $719.
[AGENT][NEUTRAL] 719 is the total bill amount?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I show that this claim was received on [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There was a benefit paid on this, well, first off, the claim number is 358-0207.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the benefit paid $25.13.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And that was on single check.
[AGENT][NEUTRAL] 2035103.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I do show that that did clear on [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Oh wow.
[CUSTOMER][NEUTRAL] Let me check one more thing.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And just so that you know that, yes, that claim is for 25 for that build amount.
[CUSTOMER][NEUTRAL] 142.
[CUSTOMER][NEUTRAL] OK, so not for 26, not both data service.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, now I'm a little confused now.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh my God, I've been to mhm.
[AGENT][NEUTRAL] I just wanted to let you know that because I looked at it because it pulled up under 25 for that bill amount.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that is
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK perfect um do you give call reference numbers?
[AGENT][NEUTRAL] Uh yes, ma'am. Uh, you would actually use my name in today's date and if you do need a copy of this explanation of benefits, [PII], we have our portal that you should be able to print it out.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh, print from rather, and our website for the portal is located at [PII].
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Am.
[AGENT][NEUTRAL] And just so you know, yes, ma'am, on the claim, the mm.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] One minute, let me go back. I erased some information I was looking at. I got off the screen too quick. So on the [PII] for the office visit, that was denied because office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so that would be patient responsibility?
[AGENT][NEUTRAL] We do not determine patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] OK, OK, perfect, thank you, that's very helpful. OK, perfect, thank you [PII] have a good rest of your day.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Well, let's.
[AGENT][POSITIVE] I hope you do too. So if that is all I can help you with, thank you again, [PII], for calling APL.
[CUSTOMER][NEUTRAL] OK bye.
[AGENT][NEUTRAL] Bye bye.