AccountId: 011433970860
ContactId: 45a2ed2d-2910-428f-906b-fe2448b2f79d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 395700 ms
Total Talk Time (AGENT): 144612 ms
Total Talk Time (CUSTOMER): 160718 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/45a2ed2d-2910-428f-906b-fe2448b2f79d_20250214T16:03_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], um, I just called you guys about a few hours ago and I got some information about a patient and said that his policy was terminated, um, in [PII], but I'm seeing um the insurance keep approving these claims, but, uh, I would say for a loud amount.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So I'm just trying to get some accurate information if you just look that up for me.
[AGENT][NEUTRAL] I sure can. So there's claims that are being approved, but you were told that the policy is terminated.
[CUSTOMER][NEUTRAL] Yes, that it was terminated in [PII]. Now he is going out of network, but they're still accepting the claims.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, right. OK, I can definitely look into that for you. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII], and my callback number is [PII].
[AGENT][NEUTRAL] Thank you, hold on.
[AGENT][NEUTRAL] And [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it is 1 2nd.
[CUSTOMER][NEUTRAL] 01545
[CUSTOMER][NEUTRAL] Oh wait, sorry. 01545882 ML 8.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's um either [PII] or [PII].
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] That was OK, because that's what it is.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] I don't know which one we go.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] I'm so sorry.
[CUSTOMER][NEUTRAL] No, you're fine.
[AGENT][NEUTRAL] It's Friday.
[CUSTOMER][NEUTRAL] I understand. And it's [PII].
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK. OK, date of birth.
[CUSTOMER][NEUTRAL] It's um [PII].
[AGENT][NEUTRAL] Thank you, and all the information provided is a verification of benefits, not a guarantee of payment. So let me see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so he did have a policy that did terminate in [PII], but he has an active policy now, that's been active since [PII], and that's the policy number, um, yeah, that's the policy number you just gave me. So this policy has been active since [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Alrighty. Now, is there any way that you can check a claim for me on this line? All righty, perfect.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And is it for the same member or it's a different member?
[CUSTOMER][NEUTRAL] Yeah, it's for the same number.
[AGENT][NEUTRAL] Oh, OK. And may I have the date of service?
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] Um, $1,603.42.
[AGENT][NEUTRAL] OK, hold on one moment and 42.
[AGENT][NEUTRAL] OK, so I'm showing received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim number is 3552169.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied. Let me get the reason for you.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] Um, the service is not is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so is the, is the $45 being put to patient responsibility?
[AGENT][NEUTRAL] So, now we don't determine patient responsibility because we're not a major medical. So if there is an outstanding balance, um, it would just be whatever your procedures are, um, write a bill, however you guys collect.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, [PII], was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Let me just make sure I got everything.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, ma'am, um, oh, is there a big, do you know if you guys would like be uploading the EOB or if there's any way that you guys can send over a fax the EOB?
[AGENT][NEUTRAL] Yes, um, we did mail the um explanation of benefits, but I can fax you a copy if you like.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Alright, what's a good fax number for you?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And should I put attention to Destiny?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Alright, so I will go ahead and fax that explanation of benefits over to you now.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help with?
[CUSTOMER][NEUTRAL] Um, do you guys do reference numbers?
[AGENT][NEUTRAL] Um, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Alrighty thank you so much. Is it on or and I'm sorry.
[AGENT][NEUTRAL] And it's OK.
[CUSTOMER][POSITIVE] OK, thank you so much, Ms. [PII], um, that's all for me. I hope you have a wonderful [PII].
[AGENT][POSITIVE] Thank you, you also, and thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.