AccountId: 011433970860
ContactId: 4b5b7139-89d0-481c-93e8-bc61c47f258d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 349850 ms
Total Talk Time (AGENT): 124287 ms
Total Talk Time (CUSTOMER): 135120 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/4b5b7139-89d0-481c-93e8-bc61c47f258d_20250321T13:37_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] [PII], my name is [PII]. I'm calling from provider office. I want to check the claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, it's uh.
[CUSTOMER][NEUTRAL] 01699646
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] One.
[AGENT][NEUTRAL] All right, and [PII], can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, it's on [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] $245.28.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Very.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, so it looks like the policy number that you gave is no longer active. Um, it was effective from [PII].
[AGENT][NEUTRAL] But there is an active policy. Um, that policy number is 247.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 3063.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And it's been active since [PII]?
[CUSTOMER][NEUTRAL] And what?
[CUSTOMER][NEUTRAL] OK. And could you please tell me the
[AGENT][NEUTRAL] So I'm gonna check with that one.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, uh, and I, I have called for this claim before I call you up, so yeah, I got the information and
[CUSTOMER][NEUTRAL] Like I'm looking for the claim status of, for this data of service like, and as for the previous trip it is, yeah.
[AGENT][NEUTRAL] I understand.
[AGENT][NEUTRAL] Right, the, the, the policy number that you gave was no longer active. So now I'm looking under the active policy for your claim. So next time just give the 2473063, that's the active policy number if you have it.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So hold on one moment, I'm looking for the claim, and it's $245 even, there's no change to it, 28 cents.
[CUSTOMER][NEUTRAL] In 200, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Nicholas Children Pediatrics.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 346.
[AGENT][NEUTRAL] 556 3.
[CUSTOMER][NEUTRAL] Yes, uh, and I, like, uh, upon checking this claim status on, uh,
[CUSTOMER][NEUTRAL] APL portal.
[CUSTOMER][NEUTRAL] With this claim number, I could not uh pull up the EOB. So I, yeah, it seems like the claim number that you just get.
[AGENT][NEUTRAL] So you just need the EOB sent?
[CUSTOMER][NEUTRAL] Yes, could you please send me the EOB?
[AGENT][POSITIVE] OK, sure. I thought you needed the claim status. I'll be more than happy to send the um EOB to you. What's a good fax number?
[CUSTOMER][NEUTRAL] OK, uh, give me a second. OK, it's [PII].
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK. Should I put attention, [PII]?
[CUSTOMER][NEUTRAL] Yeah, you can put my name.
[AGENT][NEUTRAL] OK, that was 513-9937441?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I'll go ahead and send this over to you now. Was there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, uh, like, [PII], is it the, uh, the claim denied for the office visit not cover as per the guideline and the present plan? Is it for the new policy that you just provide me, 2473063?
[AGENT][NEUTRAL] Yes, the policy number, yes, that's the active policy number.
[CUSTOMER][NEUTRAL] So, and the claim denied under that active policy number, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So under that uh active policy number, the claim is denied for office visit not covered as per the guideline and the present plan, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK. Uh thank you so much, [PII]. Yeah, could you please fax me the OB, uh, OK. That's all for now. Enjoy your weekend.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Well, thank you, I'm [PII] and thanks for calling APL. I hope you have a good day and the fax is on the way to you, OK?
[CUSTOMER][POSITIVE] Have a nice day, bye bye.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, well, thanks for calling APR. Have a great weekend.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye bye.