AccountId: 011433970860
ContactId: 49ea0340-3983-473e-8c2f-7b7270c8bc0d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 653159 ms
Total Talk Time (AGENT): 124302 ms
Total Talk Time (CUSTOMER): 352048 ms
Interruptions: 10
Overall Sentiment: AGENT=0.9, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/49ea0340-3983-473e-8c2f-7b7270c8bc0d_20241230T19:20_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling from Mclord Orthopedic Explorer to check on a claim status.
[AGENT][POSITIVE] OK, [PII], I'll be more than happy to help you with the claim status and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] this
[CUSTOMER][NEUTRAL] Um, I do have 3 claims for the same patient.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. My, one moment. The callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you for that. And the policy number?
[CUSTOMER][NEUTRAL] Yes, on the link.
[CUSTOMER][NEUTRAL] Member ID is A as in Alpha, V as in Victor, number 066.
[CUSTOMER][NEUTRAL] 9005.
[AGENT][NEUTRAL] OK, that might be their major insurance policy number. Do you have their APL policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, I'm so sorry, I don't have it.
[AGENT][NEUTRAL] OK, do you have the member's social?
[CUSTOMER][NEUTRAL] Um, I'm so sorry. I don't have it.
[AGENT][NEUTRAL] OK, what's the member's first and last name?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um it's [PII] and the last name spelled [PII]
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is it alright if I place you on a brief hold while I locate the policy?
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][NEUTRAL] So I believe I located the policy. Can you verify the member's date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, sure. Date of birth was on [PII].
[AGENT][NEUTRAL] OK, so this is a different member, um, it's a different date of birth. So there was only this one member with their first and last name, so we're gonna need more information from the insured. Um, if you can get the
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Social or the policy number will be able to assist more.
[CUSTOMER][NEUTRAL] OK, one moment. Let me check with that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] OK, there was some members so it's [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] OK, so I'm also not showing a policy with that social attached to it.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Does member have any other active policy?
[AGENT][NEUTRAL] There's no, we haven't found any policy for the member.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, does the member previously have any other policy, may I know that? Any other insurance than this?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So I can't confirm that as far as APL, there's no policy here. If the member has other insurance, you will have to check with the member.
[CUSTOMER][NEUTRAL] Do you
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] E.
[CUSTOMER][NEUTRAL] I don't.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] One, I do, I do see, uh, the members have an effective uh coverage starts from [PII], uh, with the SMS health plan. Uh, could you be able to see that?
[AGENT][NEUTRAL] OK, so ATL offers sometimes secondary insurance or supplemental insurance. The policy number that you gave starting with the AV is not an APL policy. That may be the effective and term date for that policy, but I can't tell you what that policy is because it's not here for APL. So [PII] does not have a
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I think.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] There is no policy for [PII] in APL system with his date of birth or social.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And just confirm that the patient, uh, for this member, uh, previously any other claims you have received, uh, other than, uh, this one?
[AGENT][NEGATIVE] There's no policy here. There's nothing here for him.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, thank you so much and that's all for this call.
[AGENT][POSITIVE] All right, well, thank you so much for calling APL Nora. I hope you have a great day and a happy New Year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, uh, yes, you too as well. Uh, may I have the reference number for this call?
[AGENT][NEUTRAL] So there's no call reference number. Um, you can use my name in today's date. So that's [PII].
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so much.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Yes, you too. Bye-bye.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.