AccountId: 011433970860
ContactId: 51b72a5f-b11e-4cb3-b812-0e46de5b4ca0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 430040 ms
Total Talk Time (AGENT): 124219 ms
Total Talk Time (CUSTOMER): 183821 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/51b72a5f-b11e-4cb3-b812-0e46de5b4ca0_20250220T15:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. My name is [PII]. I'm calling to check on claim status for a patient.
[AGENT][NEUTRAL] Sure, I can check on a claim for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, so it's [PII].
[AGENT][NEUTRAL] Thank you. Do you have that policy number?
[CUSTOMER][NEUTRAL] Policy number, yes. So it is 015687667 under the name of [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and do you have uh [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Yes, uh [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII] and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, I have 4 claims for this patient that we haven't received any response. Uh, we can verify the patient was first active. Uh, first date of service shows here [PII] for $224.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, I did just check, so this policy actually terminated [PII]. I did just check to see if they had any others that were active at that time and they did not.
[AGENT][NEUTRAL] Would you still like me to see if we received, yeah, [PII].
[CUSTOMER][NEUTRAL] Oh, you said [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, I believe that what happened because I, I checked also the patient's coverages and it shows another one. no problem. So, well, I think all these claims needs to be sent to another one or to the patient, um, and that's all I need, [PII], um, for this patient. Can you assist me for another patient just to verify?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, one moment, um, I'll let you know when I'm ready for that, but a separate policy number correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, yeah, I have.
[AGENT][NEUTRAL] OK, OK, yes, one moment please.
[CUSTOMER][POSITIVE] Mhm. OK. Take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, uh, you can go ahead and give me that next policy number, [PII].
[CUSTOMER][NEUTRAL] All right, next one here, it is.
[CUSTOMER][NEUTRAL] Uh, the, OK, so I have it here it.
[CUSTOMER][NEUTRAL] 01749361
[CUSTOMER][NEUTRAL] It's uh under the name of [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, uh, date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for that. What was the date of service for this one?
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] Um, well, I have an old one. The first was on [PII] or [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's the first one.
[AGENT][NEUTRAL] All right, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and just so that you are aware of this patient also their policy terminated um [PII] as well.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But it was effective [PII], so we should have received this one. Bear with me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so yes, we did receive this claim [PII] um we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Oh, it's not covered.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] All right. No problem, no problem. Um, I have 2 more claims for the same patient, and that's all.
[AGENT][NEUTRAL] Mhm, OK, what was that next data service?
[CUSTOMER][NEUTRAL] All right. Um, it's uh [PII] or [PII]. And I believe uh this is gonna be the same thing because uh this is uh office visit.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] We can make sure. Give me just a moment.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] I'm sorry, that was [PII].
[CUSTOMER][NEUTRAL] I'm sorry, no. Um, apologize. Uh, it was on [PII].
[AGENT][NEUTRAL] [PII] OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Is this a a supplemental plan, right?
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Is this a supplemental plan?
[AGENT][NEUTRAL] Yes, it's a secondary medical plan, yeah, but it is supplemental.
[CUSTOMER][NEUTRAL] That covers, OK.
[CUSTOMER][NEUTRAL] Alright, alright.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, yeah, this one is the same uh as office visits were not covered.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Alright, yeah, and the last one here, it's uh gonna be the same CPT, but we can just make sure just for the record and it was on [PII] for same bill amount.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] OK, got it thank you one moment.
[AGENT][NEUTRAL] OK, yep, this one is the same David office visits are not covered, but we did receive it.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Got it, got it. No problem. All right, well, I think I have everything what I need now and um I have a few other claims, but no problem. I think I, I just need to do a little research here and then if I need to call back again. So thank you, [PII], for your help um and I just need a call reference number.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Of course, was there anything else I can help you with?
[AGENT][NEUTRAL] Oh yeah, that would just be my first, sure, that would just be my first name, last initial, and today's date. Uh so my name is spelled [PII] is A.
[CUSTOMER][NEUTRAL] Ah, reference.
[CUSTOMER][POSITIVE] OK. All right. Thank you so much for your help, [PII]. Have a wonderful day. See you later. Mhm. Take care.
[AGENT][POSITIVE] Of course, yep, thanks for calling APL you too bye bye.