AccountId: 011433970860
ContactId: 42eeb107-599d-4070-b412-3710ca101f68
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 816229 ms
Total Talk Time (AGENT): 258212 ms
Total Talk Time (CUSTOMER): 166434 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/42eeb107-599d-4070-b412-3710ca101f68_20250228T14:50_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hi [PII], how are you? Good morning.
[AGENT][POSITIVE] Good morning.
[CUSTOMER][NEUTRAL] Um, I was calling to check eligibility and also, um, claim status on a patient please.
[AGENT][NEUTRAL] OK, so you're needing eligibility and claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] OK, then, um, yes, ma'am, I can help you with that and give me just one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and who am I speaking with please?
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[AGENT][NEUTRAL] Thank you, and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] My call back number is [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please?
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm. Certainly.
[CUSTOMER][NEUTRAL] Uh, patient ID is [PII].
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And um, any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, so I do show that he is the subscriber on this limited benefit plan and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and then, um, a claim uh for data service was of [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The data service.
[AGENT][NEUTRAL] I'm sorry, your voice cut out. What did you say, [PII]?
[CUSTOMER][NEUTRAL] It's the date of service is [PII].
[AGENT][NEUTRAL] Mhm. Total bill to me.
[CUSTOMER][NEUTRAL] Total bill is.
[CUSTOMER][NEUTRAL] 9,79089 cents.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][POSITIVE] You're welcome, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so I do show that this claim was received. The received date was [PII].
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] Processed on [PII].
[AGENT][NEUTRAL] The claim number is 3561298.
[AGENT][NEUTRAL] There was a benefit pay, uh huh.
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] I'm sorry, let me repeat that claim. It's 3561298.
[AGENT][POSITIVE] Correct. There was the benefit paid in the amount of $200.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] That was paid on single check 202.
[AGENT][NEUTRAL] 683 6.
[CUSTOMER][NEUTRAL] 202
[AGENT][NEUTRAL] And the remarks on this claim state the calendar year maximum for this benefit has been exhausted with the payment of this claim.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, ma'am, um, may I request a copy of that? I did register on the portal, uh, but I still have not received an email.
[AGENT][NEGATIVE] Um, you should not have received an email.
[CUSTOMER][NEUTRAL] Um, yes, I went to the portal and I was trying to uh.
[CUSTOMER][NEUTRAL] Just a moment let me open it again. Um, I went through the how can we help you? I went through there because um I tried to register as a new user and I did the I'm a medical.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Provide provider provider and then I right here where I have to put the patient's account number it's not letting me.
[CUSTOMER][NEUTRAL] Where I put the tax ID as well.
[AGENT][NEUTRAL] OK, now that is.
[AGENT][NEUTRAL] OK, so now on the patient account number, that is the that is the number that you all have for their patient, not the APO policy number. Some people get that confused. OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, and
[CUSTOMER][NEUTRAL] It's the policy number correct? or our number?
[AGENT][NEUTRAL] No, it is your number. It is your patient account number that you all submitted on. I believe it's box 26 of the claim.
[CUSTOMER][NEUTRAL] Oh OK, OK.
[CUSTOMER][NEUTRAL] Oh OK, just let me go ahead and try it again.
[AGENT][NEUTRAL] It's a GM number. It has GM at the beginning.
[CUSTOMER][NEUTRAL] Yes, because I was entering the the patient's ID number.
[CUSTOMER][NEUTRAL] OK just a moment please.
[AGENT][POSITIVE] Sure, absolutely.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, and the um APL do I enter the patient's name right uh the ID there?
[AGENT][NEUTRAL] I don't believe you entered their policy number at all on setting up the portal. Give me just a moment to look at that.
[CUSTOMER][NEUTRAL] Oh, I'm already in the portal.
[AGENT][NEUTRAL] Oh, OK. You're in, OK.
[CUSTOMER][NEUTRAL] I already
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Is it asking you for the information regarding the individual?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so let's see, so you should be able to use what it says to check uh for claim status.
[AGENT][NEUTRAL] You, can you enter the patient's claim number that I gave you along with their first name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then click I believe it says search.
[CUSTOMER][NEUTRAL] I don't have to enter the last 4 of the social, do I?
[AGENT][NEUTRAL] No, ma'am. It should give you three different options like a quick access or don't have an APL claim number.
[AGENT][NEUTRAL] Does it give you multiple
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let me
[CUSTOMER][NEUTRAL] Try it again.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK. The patient's first name, date of birth.
[AGENT][NEUTRAL] You can should be able to click search.
[CUSTOMER][NEUTRAL] Um, it says.
[CUSTOMER][NEUTRAL] OK, let me
[CUSTOMER][NEUTRAL] Let me clear it out because it's not letting.
[CUSTOMER][NEUTRAL] Patient's name though.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Where
[CUSTOMER][NEUTRAL] It's not
[AGENT][NEUTRAL] You should only have to enter 3 things and click search the claim number, the first name, and the date of birth.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Let me go back, no, it was asking me.
[CUSTOMER][NEUTRAL] Let me see, let me go here.
[AGENT][NEUTRAL] Because I think there's like 3 different columns. One says quick access maybe, one says don't have an APL claim number, so only fill in the quick access since you set it up.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Mhm with the claim number, first name, and date of birth, and then click search. There should be a, I think it's green.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's our claim number or your claim number?
[AGENT][NEUTRAL] The claim number I gave you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah it's saying um.
[CUSTOMER][NEUTRAL] It's saying 0 claim.
[AGENT][NEUTRAL] OK, sometimes with this type of policy that happens and I'm not sure honestly, Irma why. What is a good fax number and I'll just send this one to you.
[CUSTOMER][POSITIVE] Thank thank you so much.
[AGENT][POSITIVE] You're welcome. Uh-huh.
[CUSTOMER][NEUTRAL] Uh, [PII], uh, it's [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, does it need to have your attention on it?
[CUSTOMER][NEUTRAL] No, it just comes directly to me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And again that number is the fax number is [PII].
[CUSTOMER][NEUTRAL] Yes ma'am, do you guys give uh call reference numbers?
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] Yes, you would actually use my name along with today's date.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, thank you so much ma'am.
[AGENT][POSITIVE] You're welcome. So I have just sent that to you, Arma so you should be getting that, um, provided that there's not any type of technical problem, uh, within just the next few minutes.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Well, you're certainly welcome. So again, is there anything else I can help you with this morning?
[CUSTOMER][POSITIVE] Uh, no, ma'am, that was it thank you.
[AGENT][POSITIVE] OK, well, you're welcome and thank you for calling APL. I hope you have a wonderful weekend.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] Uh-huh. Thank you. Bye-bye.