AccountId: 011433970860
ContactId: 47461ff8-d28d-4227-ba0b-3b825aea3f24
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 439089 ms
Total Talk Time (AGENT): 144518 ms
Total Talk Time (CUSTOMER): 138046 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/47461ff8-d28d-4227-ba0b-3b825aea3f24_20250127T18:01_UTC.wav
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[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling on behalf of provider office to check on a claim status.
[AGENT][NEUTRAL] OK, I can check on a claim for you, [PII]. Uh, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII] direct line. Can I have your name, please? I just missed the starting. It's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Oh thank you so much for that.
[AGENT][NEUTRAL] Of course. And then did you have the policy number?
[CUSTOMER][NEUTRAL] Yes, it's 02399312.
[AGENT][NEUTRAL] OK, thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] All right, thank you for verifying that, [PII]. Uh, what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII] and the total charge is $104.88. And I do have a specific question regarding the claim whenever you're ready.
[AGENT][NEUTRAL] OK, uh, did you have that claim number?
[CUSTOMER][NEUTRAL] Uh, one moment. Let me check that.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, the claim number is 352-7449.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] And this was a dermatology Associates.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, yes, I did find it looks like we paid a benefit of $25 and that did meet their maximum for services provided during this office visit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, but upon checking here, there is a leftover balance of $10.41 right?
[AGENT][NEUTRAL] Yes, we don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] The maximum paid is $25 correct? And the remaining rest is of the provider responsibility, correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One moment, please.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm. OK. Uh, can I have a call to transfer this patient and add one more claim for the day for the same patient but different date of service. So could you please help me out with that?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, um, the reference number would just be the same for both, uh, so that would be my first name, last initial, and today's date, and my last initial is [PII], and you did say this next claim was for the same member, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, um, you can go ahead and give me that next day of service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The next date of service would be
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That was [PII]. Did you have this claim number as well?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] You don't have this claim number, OK, uh, let's see, uh, what was the bill amount for this claim?
[CUSTOMER][NEUTRAL] $109.
[CUSTOMER][NEUTRAL] 62 cents.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have the um well, is this for the same provider, [PII], that the dermatology associates?
[CUSTOMER][POSITIVE] Yes. And unfortunately, like, uh, I'm so sorry, like I don't have a claim number. I'm so sorry for that. I just got it now. If I, if you're OK.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Oh, no, that's fine.
[AGENT][NEUTRAL] Yeah, go ahead.
[CUSTOMER][NEUTRAL] It's 3,553,290.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I do ask the small specific question like whenever you're ready.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Oh, OK, so this, this one was for um [PII].
[CUSTOMER][NEUTRAL] Yes. No.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I I see it under [PII]. I don't see it for [PII].
[CUSTOMER][NEUTRAL] No, it's for the [PII] only, like the same number.
[AGENT][NEUTRAL] OK, I did not find the claim under him. I did find it under [PII], the spouse.
[CUSTOMER][NEUTRAL] Yes, [PII]. Plus [PII].
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK, OK. All right, give me just a moment, let me take a look.
[AGENT][NEUTRAL] OK, so for this claim, [PII], we are needing a copy of the primary EOB.
[CUSTOMER][NEUTRAL] OK. Like, uh, can I have the mailing address to be submitted to the, the with the primary hobby?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. We need to submit the primary will be to this mailing address, correct?
[AGENT][POSITIVE] That's correct. I also have a uh fax number if you'd like that.
[CUSTOMER][NEUTRAL] OK. The fax number is?
[AGENT][NEUTRAL] Did you want that? Yes, it is [PII].
[CUSTOMER][POSITIVE] Yes, I will.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] 3.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the claim number is 355.
[CUSTOMER][NEUTRAL] 3290. Is it right?
[AGENT][NEUTRAL] Yes, and it was for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The call reference is same correct your name and the date.
[AGENT][POSITIVE] Yes sir, yes.
[CUSTOMER][POSITIVE] Thank you so much for that. That's it for today. Have a great day. Bye for now.
[AGENT][POSITIVE] Alright, yeah, thanks for giving us a call, [PII]. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Bye bye.