AccountId: 011433970860
ContactId: 4db41eac-fced-4d1d-a32a-71948bfba52a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 356790 ms
Total Talk Time (AGENT): 117060 ms
Total Talk Time (CUSTOMER): 126990 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/4db41eac-fced-4d1d-a32a-71948bfba52a_20250225T13:30_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] 10, my name is [PII]. I'm calling to follow up on claim status.
[AGENT][NEUTRAL] OK, are you calling from a provider's office or are you the policy holder?
[CUSTOMER][NEUTRAL] Provider's office.
[AGENT][NEUTRAL] And the policy number?
[CUSTOMER][NEUTRAL] That would be
[CUSTOMER][NEUTRAL] You need the number or the patient's name?
[AGENT][NEUTRAL] Policy number
[CUSTOMER][NEUTRAL] It's D for Delta 43510527.
[AGENT][NEUTRAL] OK, do you have a copy of the ID card? Our number's gonna start with a 0.
[CUSTOMER][NEUTRAL] 0, hold on one second, let me look at it.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Like a policy er number?
[CUSTOMER][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] Pulling up the card now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 00250.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 1016.
[AGENT][NEUTRAL] 025010.
[CUSTOMER][NEUTRAL] 016.
[AGENT][NEUTRAL] 16, OK. And what's a good phone number, [PII], in case we're disconnected?
[CUSTOMER][NEUTRAL] Direct number is [PII].
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is.
[CUSTOMER][NEUTRAL] Second, I have [PII], last name [PII]
[CUSTOMER][NEUTRAL] I have a date of birth uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] You said you're checking claim status?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Mhm. For what date of service?
[CUSTOMER][NEUTRAL] Say the service is for.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the total charge?
[CUSTOMER][NEUTRAL] Total charge amount is for.
[CUSTOMER][NEUTRAL] $1,602.04.
[AGENT][NEUTRAL] And is this, uh, the, the urgent care visit?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on this claim I'm showing that that that office visit fee, there was a benefit of $50 which is the maximum benefit amount per day.
[AGENT][NEUTRAL] And then it looks like there was some immun some, was it vaccinations, immunizations, those are not covered by the policy.
[AGENT][NEUTRAL] So those charges were not payable?
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] What's the claim number?
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 0769 and I showed that this claim was processed on [PII].
[CUSTOMER][NEUTRAL] Is there any way I can get a faxed copy of that EOB?
[AGENT][NEUTRAL] You can, um, it was mailed when we issued the check and it can also be downloaded from our online service center. I can help you create the account to download the ELB if you would like.
[CUSTOMER][NEUTRAL] It means that because we're working from home, so I won't be able to get that EOB if it went to the PO box.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] How would I go about getting the EOV?
[AGENT][NEUTRAL] OK, what is your fax number? And does it go to the office? Maybe somebody in the office received it if you're working from home?
[CUSTOMER][NEUTRAL] I can give you the the the fax number to the office if that would be helpful.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it is 470.
[CUSTOMER][NEUTRAL] 737.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And so when it's mailed to the office, who intercepts the check in the EOB?
[CUSTOMER][NEUTRAL] And they
[CUSTOMER][NEUTRAL] Um, posting will get the, they post the payment. They make it, it's up to us to get the EOBs posted from home, so, um, I can have one of the ladies in the um office to um send it to me once it's faxed over.
[AGENT][NEUTRAL] Yeah, because the ELB is attached to the check.
[CUSTOMER][NEUTRAL] I mean, I can send it to posting, that's what I have to do.
[AGENT][NEUTRAL] OK, what I'm saying is when we process the check, the EOB is attached to the check, so I'm saying perhaps it's already received.
[CUSTOMER][NEUTRAL] Once I
[AGENT][NEUTRAL] In the office, the EOB.
[CUSTOMER][NEUTRAL] For some not posted it, it, it has not posted, ma'am.
[AGENT][NEUTRAL] I mean, I can fax it to you, but that's just an FYI the check the EOB is attached to the check.
[CUSTOMER][POSITIVE] OK, thank you so much. Will you fax it to me this time?
[AGENT][NEUTRAL] But I can fax it to the number that you gave me. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there a reference number for our call?
[AGENT][NEUTRAL] You'll use my name in today's date as your reference, [PII] and then first initial of my last name is [PII]. And did you have any other questions, [PII]?
[CUSTOMER][POSITIVE] No, ma'am, that will be all. I do appreciate your help.
[AGENT][POSITIVE] Oh, you're welcome. Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.