AccountId: 011433970860
ContactId: 41abd1c8-aff8-4318-b56a-1df9692ac720
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 415980 ms
Total Talk Time (AGENT): 189453 ms
Total Talk Time (CUSTOMER): 72882 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/41abd1c8-aff8-4318-b56a-1df9692ac720_20250214T19:13_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] calling from Huntsville Care Plus, and I was trying to check on a claim.
[AGENT][POSITIVE] OK, well, I'm more than happy to help you with the claim status, [PII]. May I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, phone number is [PII].
[CUSTOMER][NEUTRAL] And the member's policy number is 997788.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mhm, [PII], or actually I'm calling about [PII]. Date of birth [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 um data of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Mhm. I've got two. The first one is 6-172024.
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] $150.
[AGENT][NEUTRAL] So for [PII] for [PII], um there's no claim on file?
[CUSTOMER][NEUTRAL] OK, what about data service 11724?
[CUSTOMER][NEUTRAL] Also $150.
[AGENT][NEUTRAL] 11 7 24.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, there's no claim on file for [PII] either. Let me see, hold on one moment.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] I was gonna say what's the best way for me to submit a claim?
[AGENT][NEUTRAL] Well, hold on one second, because this uh policy.
[AGENT][NEUTRAL] This was their first policy. This time back in [PII]. Let me check with their active policy to see if there's a claim.
[AGENT][NEUTRAL] Hold on one moment, 2,030,130.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so the new policy number is 2,030,130.
[AGENT][NEUTRAL] And it's been active since [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I am looking now for the 2 dates of service to see if there's claims here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So for [PII], there's a claim, hold on one moment.
[AGENT][NEUTRAL] Let me look for the other one and then I'll give you both of them.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so for [PII], that claim number is 348.
[AGENT][NEUTRAL] 773 8.
[AGENT][NEUTRAL] And it was received on [PII].
[AGENT][NEGATIVE] And on [PII], it was denied. Hold on one moment, I'm pulling up that denial reason.
[AGENT][NEUTRAL] Um, the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the other um for the for [PII], we received on [PII].
[AGENT][NEUTRAL] My claim number is 355.
[AGENT][NEUTRAL] 9579.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim to the provider a total of $50.
[CUSTOMER][NEUTRAL] OK, was that by check or?
[AGENT][NEUTRAL] Yes, that was a single check. Um, did you need the check-in information?
[CUSTOMER][NEUTRAL] Place.
[AGENT][NEUTRAL] Alright, so it's check number 2025982.
[AGENT][NEUTRAL] It was issued on [PII] to Huntsville Care Plus.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 11
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Wait, let me see how many [PII].
[CUSTOMER][NEUTRAL] And 2425 of this year.
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] OK, [PII]. OK, um, is there a way to get an EOB online?
[AGENT][NEUTRAL] Um, yes, through the online service center. You can get your explanation of benefits, um, once you create an account as a provider. Um, I can also fax you over a copy if you need one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Please, if you don't mind.
[AGENT][POSITIVE] I don't mind at all. What's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And should I put attention, [PII]?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Alright, and that was [PII]. Attention, [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And did you need both um explanation of benefits or just this last one?
[CUSTOMER][POSITIVE] Uh, both would be great.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] So I'll go ahead and send this over to you now. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Mm just a reference number.
[AGENT][NEUTRAL] So there's no call reference number, but you can, you can use my name in today's date, which is [PII].
[CUSTOMER][POSITIVE] OK, alright, thank you very much.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] You too. Thanks.
[AGENT][POSITIVE] You're welcome bye bye.