AccountId: 011433970860
ContactId: 4fefd215-0db5-4079-b23f-53fcba6bc027
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 571700 ms
Total Talk Time (AGENT): 166791 ms
Total Talk Time (CUSTOMER): 160939 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/4fefd215-0db5-4079-b23f-53fcba6bc027_20250527T13:39_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. How are you doing today?
[AGENT][POSITIVE] I'm doing well, [PII]. How are you?
[CUSTOMER][NEUTRAL] Not too bad. I am calling because we submitted um additional information that you guys needed via fax um because you were denying a claim um and needed the primary info and I'm just trying to follow up on that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, I can definitely help you with the claim status and see if the um primary, was it the explanation of benefits that was asked for?
[CUSTOMER][NEUTRAL] Yes, um, so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It looks like the claim was voided in our system, so I don't have a claim number to give you, um.
[CUSTOMER][NEUTRAL] But I do have the date of service and OK.
[AGENT][NEUTRAL] Oh, it's OK.
[AGENT][NEUTRAL] Um, well, may I have a good contact number in case we're disconnected, and then do you have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, so my callback number is [PII] and it's a direct line and then the policy number is 60801.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that's our payer ID. Um, do you have a copy of the member's ID card there?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Give me 1 2nd, let me check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That is for whatever reason is what is loaded in our system.
[CUSTOMER][NEUTRAL] But you said that's the payer ID which is a little weird, but mistakes happen.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Weird mistakes, but it happens.
[AGENT][NEUTRAL] It happens.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] See
[CUSTOMER][NEUTRAL] I see group.
[AGENT][POSITIVE] I can do the group, um, I can look forward to the group as well.
[CUSTOMER][NEUTRAL] OK, it's 25,680.
[AGENT][NEUTRAL] OK hold on one moment.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] OK. And can you verify the member's first and last name?
[CUSTOMER][NEUTRAL] Yes, [PII], it's [PII], sorry, [PII]
[AGENT][NEUTRAL] All right, and her date of birth?
[CUSTOMER][NEUTRAL] That is going to be [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. Um, so the policy number is 25562663.
[AGENT][NEUTRAL] And let me check the claims for you.
[AGENT][NEUTRAL] What's the date of service and the total bills?
[CUSTOMER][NEUTRAL] It's [PII] for $526 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold, [PII], while I take a look into the claims?
[CUSTOMER][NEUTRAL] Sure thing.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Let's see if it's working.
[AGENT][NEGATIVE] Oh, still not working.
[AGENT][NEUTRAL] Oh man.
[AGENT][NEUTRAL] What?
[AGENT][NEUTRAL] How does all that they what?
[AGENT][NEUTRAL] How's that all that's there?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, and.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, hello [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] All right, thank you so much for holding. I apologize for that wait. So,
[AGENT][NEUTRAL] We received the claims, but
[AGENT][NEGATIVE] OK, so the first time it was denied requesting an explanation of benefits from primary insurance and then we received it again, but there is just new dates of it's like a new claim form with new dates of service, the [PII], and [PII], but there's still no explanation of benefits.
[CUSTOMER][NEUTRAL] OK. Now, I did submit a fax with the primary EOB on [PII].
[AGENT][NEUTRAL] Of this year?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] We have a
[AGENT][NEUTRAL] We haven't received anything from for this claim or this uh policy since [PII]. What fax number did you send it to?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, that's the correct fax number you said [PII]?
[AGENT][NEUTRAL] It should have
[CUSTOMER][NEUTRAL] Mhm. And I think the issue is the policy number that is listed on it. I did not know it was your payer ID.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, so then
[CUSTOMER][NEUTRAL] All the other information is correct.
[AGENT][NEUTRAL] Yeah, but it's not here and I don't know if that's like, you know, I don't, I don't know what happened and it's not here, but you can resubmit it and then if you want to put the um
[AGENT][POSITIVE] That policy number that I just gave you on the the active policy number, hopefully we'll get it this time.
[CUSTOMER][NEUTRAL] The 255.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 626-3.
[CUSTOMER][NEUTRAL] 626-3. OK. All right.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Cause I just looked at both of the um the original and the second claim that came in, but it's just the, the claim form.
[CUSTOMER][NEUTRAL] OK dokey.
[CUSTOMER][NEUTRAL] OK. And can you give me the original claim number that's denying for the um primary EOB?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, it's 356.
[AGENT][NEUTRAL] 4575.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So just to make sure I got that right, you said 356-457-5.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And that's the original plan that's denying for the needing the the primary EOB.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect. All right. And then can I get a call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK, perfect. Well, thank you so much, [PII]. I really do appreciate all your help.
[AGENT][POSITIVE] You're very welcome, [PII]. Thank you for calling APL and I hope you have a good day.
[CUSTOMER][POSITIVE] Thanks you too. Bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.