AccountId: 011433970860
ContactId: 4608f7ee-77c0-45bd-b4a1-7d341eefc41d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 998690 ms
Total Talk Time (AGENT): 253117 ms
Total Talk Time (CUSTOMER): 461105 ms
Interruptions: 20
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/4608f7ee-77c0-45bd-b4a1-7d341eefc41d_20250422T18:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling for provider uh try and NA. Please note this call has been monitored and recorded for quality and training purpose, and I'm calling to obtain status on a claim.
[AGENT][NEUTRAL] Oh, I could check on a claim for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, callback number is [PII].
[AGENT][NEUTRAL] Thank you. And do you have that policy number?
[CUSTOMER][NEUTRAL] And the member ID is D as in Delta 43410377.
[AGENT][NEUTRAL] OK, so [PII], that's not one of our policy numbers. That is through, they're called 90 degree benefits, so I can give you their information and transfer you to them, um, or if you have the member's social, I can see if they have a policy with us.
[CUSTOMER][NEUTRAL] She's
[CUSTOMER][NEUTRAL] OK, so as per checking for this number, I don't have the social, but I'm just stating that uh.
[CUSTOMER][NEUTRAL] It is not your member. Yes.
[AGENT][NEUTRAL] The policy number that you gave me, that member ID is not through us, that is through a 90 degree benefit.
[CUSTOMER][NEUTRAL] So on that number only I've called uh to the 90 degrees benefit, OK.
[AGENT][NEUTRAL] If you have
[AGENT][NEUTRAL] Uh, I can give you their information and transfer you if you'd like, um, or the only other way I can search to see if they might have a policy with us is, uh, if you could spell out their first and last name.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so the member's name is [PII].
[CUSTOMER][NEUTRAL] Spelled as [PII].
[CUSTOMER][NEUTRAL] And the last name is [PII] spelled as [PII].
[AGENT][POSITIVE] OK, OK, thank you one moment.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, so the mailing address which I provided for you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And it's.
[AGENT][NEUTRAL] OK, and then do you have the date of birth?
[CUSTOMER][NEUTRAL] Uh, date of birth is uh [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. So she did have a policy with us, um, it did terminate [PII]. What was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So the date of service was uh [PII].
[CUSTOMER][NEUTRAL] Yeah that's that's.
[AGENT][NEUTRAL] That was [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what was that bill amount please?
[CUSTOMER][NEUTRAL] Uh, the bill amount is $309 even.
[AGENT][NEUTRAL] 309. OK, thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] that's
[AGENT][NEUTRAL] Was the provider, was that Heartland Women's Healthcare?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] One moment, I found a, looks like we received this claim a couple of times. Bear with me just a moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So, before you help me with that, we have recently submitted the claim on [PII].
[AGENT][NEUTRAL] Yeah it looks like we received it a few times. I'm trying to find the original Give me just a moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, sorry about that wait, [PII]. I did find the original claim looks like it was submitted to us several different times, um, OK, so we were able to pay a benefit of $75 which was the maximum amount payable for this date of service.
[CUSTOMER][NEUTRAL] Go.
[CUSTOMER][NEUTRAL] I'm calling.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'm really sorry, ma'am. May I know when did you receive the original claim and what's the status for that one?
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] So when did you receive the claim and when when it was processed?
[AGENT][NEUTRAL] Yes, so the original claim we received that [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][NEUTRAL] Some deep sound.
[CUSTOMER][NEUTRAL] You found your call on this one.
[CUSTOMER][NEUTRAL] After that, directly with the can claim a all of that.
[CUSTOMER][NEUTRAL] I think I'm
[CUSTOMER][NEUTRAL] This is on [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so may I know what the status for that? It has been processed and paid or it has been denied?
[AGENT][NEUTRAL] Yes, we paid a benefit of $75 which was the maximum amount payable for the state of service.
[CUSTOMER][NEUTRAL] I, I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] The allow amount and the paid amount will remain the same, $75 even.
[AGENT][NEUTRAL] We paid $75 yes.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Is there any patient responsibility?
[AGENT][NEUTRAL] We don't say what is patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So it was paid by check or EFT.
[AGENT][NEUTRAL] It was sent by a paper check in the mail.
[CUSTOMER][NEUTRAL] Can you give me the check number?
[AGENT][NEUTRAL] Check number is
[CUSTOMER][NEUTRAL] And the amount for the check.
[AGENT][NEUTRAL] It was for $75. The check number is 1863039.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. And can you please
[AGENT][NEUTRAL] And the check was, it was issued [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And I am showing it did clear [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So, can you please help me with the uh
[CUSTOMER][NEUTRAL] A copy of your.
[AGENT][NEUTRAL] Yes, I can send that to you. Uh, do you have a fax number?
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] Yes, so the fax number is [PII].
[CUSTOMER][NEUTRAL] Attention to the patient account number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm gonna read that back to you to make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and then that would the attention would be 747287V as in Victor 21608.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I know how much time it will take to be received?
[AGENT][NEUTRAL] Um, I'm going to go ahead and send it now. You should get it within about 10 minutes or so.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, and the claim number will be?
[AGENT][NEUTRAL] That is 3481454.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Um, uh, yesterday, uh, it was originally received process, so the process and the pay date will remain the same. [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and can you please help me with the
[CUSTOMER][NEUTRAL] A payment mailing address.
[AGENT][NEUTRAL] Our mailing address is [PII].
[CUSTOMER][NEUTRAL] No, no, uh, I'm asking to which address you be was sent.
[AGENT][NEUTRAL] Oh, the address that we sent it to you? OK, one moment.
[CUSTOMER][NEUTRAL] How much is it?
[AGENT][NEUTRAL] So that was sent to [PII].
[CUSTOMER][NEUTRAL] That's.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] That mean I think uh [PII].
[CUSTOMER][NEUTRAL] I don't.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK. And yes, sir, as you help me with the information, so a call reference number will be.
[AGENT][NEUTRAL] OK. Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, yes, I do have one other claims to discuss. So for this claim, what will be a call reference number?
[AGENT][NEUTRAL] The reference number would just be my first name, last initial, and today's date. And so my name is spelled [PII]
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's it.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] on the [PII].
[CUSTOMER][NEUTRAL] OK, so can you please go, uh, yes, when you're ready, yes, we can move on to the next one. And uh may I know what about the recent one, the claim which we have submitted? Yes.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] I'm so sorry.
[AGENT][NEUTRAL] OK, I'm sorry, [PII], could you repeat all of that, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh yes, so for this claim as well be the original status for this claim, yes, I paid information. So can you please help me with the
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That, uh, the recent claim which you have submitted. When did you receive the recent one?
[AGENT][NEUTRAL] The most recent one, you mean the um the duplicates?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, yes, when, uh, when it was received.
[AGENT][NEUTRAL] You mean the duplicate claims?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, we've received several, uh, do you want me to check all of those for you?
[CUSTOMER][NEUTRAL] No, the recent one.
[AGENT][NEUTRAL] The most recent? OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The most recent one.
[AGENT][NEUTRAL] Was [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And that was processed [PII].
[AGENT][NEGATIVE] And it was denied as it was a duplicate.
[CUSTOMER][NEUTRAL] And denied on which date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you. So when I'm ready, yes, I, uh, can we, we can move on to the next one.
[AGENT][NEUTRAL] Um, give me just a moment. I'll let you know.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], uh, uh, you can go ahead and give me that next policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Yes, it is C as in Charlie, V as in Victor 01402769.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I'm audible.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, are you there?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I uh I.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, no, no, no, I mean, uh.
[CUSTOMER][NEUTRAL] I know