AccountId: 011433970860
ContactId: 5294d5bc-ca9e-4053-a51e-68c48305dd2a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 304679 ms
Total Talk Time (AGENT): 111605 ms
Total Talk Time (CUSTOMER): 92082 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/5294d5bc-ca9e-4053-a51e-68c48305dd2a_20250114T17:00_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I am calling about a couple of claims for a patient and also basically to verify whether she still has this coverage.
[AGENT][POSITIVE] Um, yes, ma'am. I can assist you.
[CUSTOMER][NEUTRAL] We don't have a copy of her. OK, thanks, we don't have a copy of her card, so I, I just guessed on your automated system which button to press.
[AGENT][NEUTRAL] OK, yeah, I can look her up by her name or either her social. Um, first, let me get your name and a good callback number.
[CUSTOMER][NEUTRAL] It's [PII] and it's [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII] and you don't have her policy number. Do you have her social?
[CUSTOMER][NEUTRAL] I have her ID number. I mean, she, we have the information. I just don't have a copy of her card to look at, so her ID number is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. Now, please verify her name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, yes, ma'am. And just let me advise you that verification of coverage does not guarantee payment of claims. Um, I'm showing the effective date on the policy is [PII]. And right now, I'm showing that the policy is still active.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And can you look up two claims for me?
[AGENT][NEUTRAL] Um, yes, ma'am. Do you have the claim number or the date of service and bill charges?
[CUSTOMER][NEUTRAL] Data I have the data service for the first one is 1024, 2024 build amount $20.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK. Yes, ma'am. I'm showing that this um claim denied because the benefit maximum was reached um under, under this policy for outpatient office visits as well. We covered up to $50 per visit and that was maxed out on a previous claim.
[CUSTOMER][NEUTRAL] OK, we don't have uh any OB for that and we need that in order to send it on to Medicaid.
[AGENT][NEUTRAL] OK, I can fax that over to you. What's your fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And would I attention it to you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, OK. One moment.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. And just so you know, um, have the claim information. We received the claim on 11-21-24.
[AGENT][NEUTRAL] Um, well, we received it on 11-7-24 and it processed on [PII] and the claim number is 352-7209.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you and the last claim, the last claim is 13-2025 bill amount $200.
[AGENT][POSITIVE] Mhm. No problem.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I understand that this one's not processed yet. I just wanna make sure that you have it.
[AGENT][NEUTRAL] Um, actually, I'm not showing that claim on file. How was it submitted?
[CUSTOMER][NEUTRAL] Um, let me look.
[CUSTOMER][NEUTRAL] Paper.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I can resend it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And we also have a fax number that you can fax claims to.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Oh, that would be wonderful. What is the fax number?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 942-3 and please attention it to the claims department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you for your help.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Nope, that would be it.
[AGENT][POSITIVE] OK. Well, I thank you again, [PII] for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye bye.