AccountId: 011433970860
ContactId: 4edeae66-6741-4047-aa55-b06a86f1afed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 775460 ms
Total Talk Time (AGENT): 186432 ms
Total Talk Time (CUSTOMER): 320038 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/4edeae66-6741-4047-aa55-b06a86f1afed_20250116T14:03_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, hi, this is [PII], and I'm calling from provider office, and I want to know about claim information. Could you please help me also for that?
[AGENT][NEUTRAL] Sure, I could assist you with that. You said your name was [PII]?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Or [PII].
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Can I have a callback number for you?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you [PII]. Can I have the the policy number of the member that you're inquiring eligibility for today?
[CUSTOMER][NEUTRAL] Yeah. The policy number is
[CUSTOMER][NEUTRAL] Just give me a second.
[CUSTOMER][NEUTRAL] It is 02042058 M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] Thank you. Could you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII] and the date of birth of this member is [PII].
[AGENT][NEUTRAL] And you're calling to verify benefits eligibility for what place of service?
[CUSTOMER][NEUTRAL] The place, the date of service you mean, right?
[AGENT][NEUTRAL] I'm sorry, dear, you call us to check the status of a claim. What's the date of service?
[CUSTOMER][NEUTRAL] Yeah. The date of service is [PII].
[AGENT][NEUTRAL] This is a facility, a facility claim?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm not showing the claim on file.
[CUSTOMER][NEUTRAL] It is for provider service.
[AGENT][NEUTRAL] Is it one claim?
[CUSTOMER][NEUTRAL] Uh, the cream is
[CUSTOMER][NEUTRAL] Uh, yeah, it, uh, actually, I have like, uh, just give me a second.
[AGENT][NEUTRAL] Cause I need one data service.
[CUSTOMER][NEUTRAL] No, no, no. The date of service is um [PII]. That's it.
[AGENT][NEUTRAL] OK, I'm not showing a claim on file for the data service for facility charge.
[CUSTOMER][NEUTRAL] Mhm. OK. So could you please provide me the uh uh member effective or term there something else?
[AGENT][NEUTRAL] Is it a
[AGENT][NEUTRAL] This policy has been active since.
[AGENT][NEUTRAL] [PII] and is currently active.
[CUSTOMER][POSITIVE] OK. Thank you so much for this information. Uh, actually, I have 3 more claims. Could you please help me also for those claims?
[AGENT][NEUTRAL] With the same member
[CUSTOMER][NEUTRAL] Uh, no, the number is different.
[AGENT][NEUTRAL] Give me one moment please.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] And before that, could you please provide me the call reference number for this claim?
[AGENT][NEUTRAL] We don't provide those.
[AGENT][NEUTRAL] Use my name in today's date as a reference. Can I have the next policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. It is 18522275.
[AGENT][NEUTRAL] And what is the member's name and date of birth that you're inquiring claim status for? Give me the number again 185.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, it is 18522275.
[AGENT][NEUTRAL] It's not pulling up a policy. Could you verify that the policy number that you provided is correct?
[CUSTOMER][NEUTRAL] Yeah, I just uh double check in my system. Just give me a second.
[CUSTOMER][NEUTRAL] Oh I know, honey, I know.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] The policy number is
[CUSTOMER][NEUTRAL] There is no mentioning the policy number. There is mentioning group number.
[AGENT][NEUTRAL] Do you have a card?
[CUSTOMER][NEUTRAL] Yeah, uh, I have a card and I
[AGENT][NEUTRAL] It should say insert or insert or out in inpatient or outpatient, one of those numbers.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, just give us. It is for outpatient.
[AGENT][NEUTRAL] OK, what is that policy number that says outpatient cert number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It means group number, you need group number for this?
[AGENT][NEUTRAL] No, no, no, do we say inpatient, outpatient er number on the card?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Are you looking at the card?
[CUSTOMER][NEUTRAL] Yeah, I'm looking at the card and there is like uh um
[CUSTOMER][NEGATIVE] There is no any um policy number given. There is mentioned only group number.
[AGENT][NEUTRAL] So, on the car, what does the card say?
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] Outpatient benefit sir number. You need this, right?
[AGENT][NEUTRAL] Yes, that is the policy number. Yes, the 3rd number is the policy number.
[CUSTOMER][NEUTRAL] Oh, OK, OK. It is 1281255 ML 8.
[AGENT][NEUTRAL] Thank you. Could you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it is uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] The date of birth is
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And this is for who?
[CUSTOMER][NEUTRAL] Uh, sorry?
[AGENT][NEGATIVE] Those birthdays and the name does not match.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You said this is for [PII] and the date of birth does not match [PII]'s date of birth that we have on file.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Uh, I don't have any other date of birth for this. OK, no problem. Thank you so much for this. So may I provide you the next member ID?
[AGENT][NEUTRAL] Yes, what is the policy number?
[CUSTOMER][NEUTRAL] Just give me a second.
[CUSTOMER][NEGATIVE] Date of birth is incorrect.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] The next one is
[CUSTOMER][NEUTRAL] It is 02221660. M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] Give me that number one more time.
[CUSTOMER][NEUTRAL] Yeah, it is 02221660 ML8.
[AGENT][NEUTRAL] Could you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The name of the patient is [PII] and the date of birth is
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service that you're inquiring for [PII]?
[CUSTOMER][NEUTRAL] Um, it is [PII].
[AGENT][NEUTRAL] And what is your procedure code?
[CUSTOMER][NEUTRAL] OK. Uh, just give me a second. I just check the process the code.
[CUSTOMER][NEUTRAL] For this
[AGENT][NEUTRAL] The procedure code or the bill amount?
[CUSTOMER][NEUTRAL] OK. Uh, the bill amount for this claim is 2,62008 cents and the procedure for
[AGENT][POSITIVE] Thank you. I sent the claims.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This claim was received [PII]. It was processed [PII]. There was no payment made on this claim, and it was because the member we're requesting the primary EOB to be sent in. This is the gap insurance and we need the primary EOB.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, so do you provide me the claim number for this?
[AGENT][NEUTRAL] 353-7067
[CUSTOMER][NEUTRAL] 7067. And could you please receive or repeat the receive or process it because your voice broke up that time.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] This claim was received.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII] and it was processed [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, uh, just give me a sec.
[CUSTOMER][NEUTRAL] [PII]. OK, thank you so much for this information. So, may I provide the last member ID?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, so the last one is.
[CUSTOMER][NEUTRAL] 01772 01770256.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Uh, it is [PII], and the date of birth of this member is
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And what is the date of service that you're inquiring claim status for [PII]?
[CUSTOMER][NEUTRAL] The date of service is
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm not showing the claim on file for the data service.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So the claim is not on file on the data service.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. And uh um
[CUSTOMER][NEUTRAL] Could you please provide me the details for the member eligibility?
[CUSTOMER][NEUTRAL] Effective or term date something?
[AGENT][NEUTRAL] Give me one moment please if you don't mind.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] This policy was effective [PII] and it was terminated [PII] and there's no active policy on file.
[CUSTOMER][NEUTRAL] Uh, it is term on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK.
[CUSTOMER][POSITIVE] OK. Thank you so much. And could you please spell your name?
[AGENT][NEUTRAL] Of course, [PII].
[CUSTOMER][POSITIVE] OK. OK. Thank you so much for this, [PII], for your all information and have a great day.
[AGENT][POSITIVE] Thanks for calling APL. You have a great one as well, [PII]. Goodbye.
[CUSTOMER][NEUTRAL] Bye bye.