AccountId: 011433970860
ContactId: 539badef-1610-4a58-8a6b-42898ae5d867
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 353730 ms
Total Talk Time (AGENT): 117859 ms
Total Talk Time (CUSTOMER): 209838 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/539badef-1610-4a58-8a6b-42898ae5d867_20250206T18:08_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEGATIVE] And uh I was um calling regarding, uh, I've spoke with two reps within the past 2 days. I spoke with one today and um they were supposed to be faxing me some EOBs. Now I did receive uh the fax from today, but it was for only 1 we had 2 days of service that were the same.
[CUSTOMER][NEUTRAL] And um they were gonna fax me something for both of those dates of services. One of them we had already and had it posted, but I'm just needing to find out if there was an actual EOB for this other claim that they were saying that they had and didn't pay.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Um, well, I'm definitely sorry you haven't received it. I'll be more than happy to look into it for you and um see if there's an explanation of benefits. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh. My name is [PII] and it's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Uh-huh 022 038-887.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Um, the is [PII], I mean, [PII], date of birth [PII].
[AGENT][NEUTRAL] All right, and thank you so much for verifying your information or her information, I'm sorry. Um, so the claim, which claim number didn't you receive 333381127 or?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Hold on for me one second though, uh, that's because I might not even need that. I, I'm, I'm sitting here looking.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Oh my gracious, because see they, they built boy wait a minute, I got the wrong data service for one I um.
[CUSTOMER][NEUTRAL] Hold on one second, let me put in this data service. 2023.
[CUSTOMER][NEUTRAL] OK, now I received the EOB for the data service 10-17-2023, and this one is for what CPT code 90834. We sent in a claim for $150 and that's the one that I had got the EOB on. We did you all did a payment of $60 on that one and we already had that one, but um.
[CUSTOMER][NEGATIVE] She sent that one again, but I was told there was another claim on file for 18,780 or something like that, which again I don't know where that one came from, so they were gonna send me something showing that too because we submitted a claim with the same date, but it was an office visit for $308 which I understand you all don't pay. I'm not seeing an EOB for that one.
[AGENT][NEUTRAL] OK, wait a minute. So now I'm getting confused. So what's the data service for the claim that you have not received?
[CUSTOMER][NEUTRAL] It's the same, 1017, 23.
[AGENT][NEUTRAL] And you, you got the one for $150 or you didn't?
[CUSTOMER][NEUTRAL] Yeah, see, I had that one, but then they told me they didn't have a claim for $308. They had another claim for $187.80.
[AGENT][NEUTRAL] OK, so it's this one.
[AGENT][NEUTRAL] You said $308 is what you're looking for?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Oh no, there's a claim on file. Hold on one second.
[AGENT][NEUTRAL] Well, first, all the information provided is a verification of benefits, not a guarantee of payment. So, um, what's the name of your provider's office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's the mean your behavioral healthcare.
[AGENT][NEUTRAL] OK, yeah, this is it. I just wanted to make sure I was looking at the right thing. Um, so yes, we have a claim that came in on [PII] for data service 10-17-2023. Um, it's procedure code 99205.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] Yeah, now both of them told me they had a claim. OK, I'm sorry.
[AGENT][NEUTRAL] But it was, it
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Um, but I can definitely fax this over to you. I'm sorry you were given the wrong information.
[CUSTOMER][POSITIVE] Oh my goodness. All right. Well, thank you so much. I said, [PII], the 3rd time is a charm, I guess. Yes, indeed.
[AGENT][POSITIVE] Well, you're very welcome.
[CUSTOMER][NEUTRAL] And they kept saying 187. I was like I don't know whose claim that is.
[AGENT][NEUTRAL] And Ms. [PII], what's a good um fax number for you for the explanation of benefits?
[CUSTOMER][NEUTRAL] It's um [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], let me spell my name for you. It's [PII] I, I don't want anybody else to get it, RI.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and it's um fax number [PII]?
[CUSTOMER][NEUTRAL] Uh uh uh [PII].
[AGENT][NEUTRAL] 0, [PII], OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then the spelling of your name, [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so I will go ahead and fax this over to you now. Was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] No, thank you very much.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.