AccountId: 011433970860
ContactId: 487d0f71-a9d7-4f8f-83c7-cbdc0fb21ab3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 293799 ms
Total Talk Time (AGENT): 140048 ms
Total Talk Time (CUSTOMER): 75726 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/487d0f71-a9d7-4f8f-83c7-cbdc0fb21ab3_20250513T13:57_UTC.wav
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[AGENT][POSITIVE] Good, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Apparently.
[CUSTOMER][NEUTRAL] Hey, I had received an EOB from an insurance company saying that they needed some information provided to y'all before they could process the claim for me, and I was calling to get that squared away.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, so you're wanting to find out how to submit the information that we were needing, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Are you the are you the insured [PII]?
[CUSTOMER][NEUTRAL] No, I work with the provider.
[AGENT][NEUTRAL] Are you calling from
[AGENT][NEUTRAL] OK, and [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please [PII].
[CUSTOMER][NEUTRAL] Um, the member ID number is 02617343.
[AGENT][NEUTRAL] OK, thank you one moment while I get the member's information pulled up please.
[AGENT][NEUTRAL] And give me your phone number one more time, [PII], please. [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And [PII], what is the data service and total bill amount that you're calling about? Oh well, first off, I'm so sorry I'm getting so ahead of myself. Any information that I provide for you, [PII] would be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it is Contravius [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you, and the date of service and total bill amount for him please?
[CUSTOMER][NEUTRAL] Um, data service is 42425. Total bill charges are 172.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] OK, and you said that you received the explanation of benefits for this number, is that correct?
[CUSTOMER][NEUTRAL] Yes, and it just says that they're awaiting information to confirm eligibility.
[AGENT][NEUTRAL] Correct, yes ma'am, and as soon as we do receive that information from benefits on a card, this claim will continue to be processed.
[CUSTOMER][NEUTRAL] OK, um, is there anything I can provide?
[AGENT][NEUTRAL] That's just letting you know that we're waiting on some of the, no, ma'am, there is not. This is something that has to come from their employer.
[CUSTOMER][NEUTRAL] OK, alrighty, um, would their employer have been notified or do I need to get the patient to contact the employer?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, they would have also the insured would have also received this explanation of benefits and again but the way their enrollment is we receive electronic files and we just have not received the file yet to confirm that, but as soon as we do, then we will, yes ma'am, we will continue reviewing so it's just kind of been a holding pattern essentially at the moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes ma'am, no worries.
[CUSTOMER][POSITIVE] OK, no worries, I'll get that charted. Thank you so much.
[AGENT][NEUTRAL] OK, well, you're welcome. And then one last thing, [PII], just for future reference, if you ever need a copy of an explanation of benefits from a policy with APL that we've processed the claim on, we do have a portal that you can check claim status in as well, and our portal website is located at secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, yes ma'am
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, one more thing, would I be able to get a reference number for this call?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] You would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] OK, and what was your name again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect thank you so much.
[AGENT][POSITIVE] OK. All right. Well, you're very welcome. So if that's all I can help you with, [PII], thank you again for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] You too. OK bye-bye.
[AGENT][POSITIVE] Yes ma'am thank you bye bye.