AccountId: 011433970860
ContactId: 59a70162-eec8-4b07-8b06-37e4b553c530
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 617299 ms
Total Talk Time (AGENT): 238292 ms
Total Talk Time (CUSTOMER): 158155 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/59a70162-eec8-4b07-8b06-37e4b553c530_20250210T18:53_UTC.wav
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[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office checking on the claim status.
[AGENT][NEUTRAL] OK, I could 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, [PII]. No [PII] direct line.
[AGENT][NEUTRAL] OK, thank you. And do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The policy number is 02450098M as in Mary, L as in Lima 8.
[AGENT][NEUTRAL] Thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Member's name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that problem. Uh, what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Date of service is [PII] and total charges of $542 even.
[AGENT][POSITIVE] OK, got it, thank you one moment.
[AGENT][NEUTRAL] OK, so we did receive this claim from, uh, we were unable to pay a, uh, excuse me, we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK. May I know when was it received?
[AGENT][NEUTRAL] Mhm. Uh, it was received [PII], and it was processed [PII].
[CUSTOMER][NEUTRAL] OK, can I have the claim number?
[AGENT][NEUTRAL] It's 3542495.
[CUSTOMER][NEUTRAL] 3542495, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. I have 2 more claims. Can you put information for that?
[AGENT][NEUTRAL] Are these gonna be for a different member or is this for the same member?
[CUSTOMER][NEUTRAL] Different member.
[AGENT][NEUTRAL] OK uh one moment I'll let you know when I'm ready.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'm ready for that next policy number.
[CUSTOMER][NEUTRAL] 02288208 M as in Mary, L as in Lima 8.
[AGENT][NEUTRAL] OK, and then the uh name and date of birth for this number?
[CUSTOMER][NEUTRAL] Member name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK thank you for that. And what was the date of service for this one?
[CUSTOMER][NEUTRAL] Date of service is [PII] and total charges are $34 7348.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] You said.
[AGENT][NEUTRAL] OK, this one is the same, [PII], uh, we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK. May I know the receipt date, process date and claim number?
[AGENT][NEUTRAL] Yes, uh, we received this claim, excuse me, [PII], and it was processed [PII].
[AGENT][NEUTRAL] Claim number is 355788887.
[CUSTOMER][NEUTRAL] 355-78887.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, can we go for the last claim?
[AGENT][NEUTRAL] Uh, one moment, please.
[CUSTOMER][POSITIVE] I'm all right.
[CUSTOMER][NEUTRAL] And I.
[AGENT][NEUTRAL] OK, I'm ready for that last policy number.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] 1071066.
[AGENT][NEUTRAL] And the name and date of birth for this number?
[CUSTOMER][NEUTRAL] My name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Thank you and then what was the date of service please?
[CUSTOMER][NEUTRAL] Date of service is [PII] and total charges are $358 358.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] I'm sorry, that was [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK, I did find a claim for this state of service prom. It was for $100 though, um, is that the amount after major medical paid?
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] Sorry, can you repeat that?
[AGENT][NEUTRAL] I did find one claim for this date of service from uh Gastro Health. It was for $100. Is that the amount after major medical pay?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see, so for this claim we did pay a benefit of $25.
[AGENT][NEUTRAL] And that did meet their maximum amount uh during that office visit.
[CUSTOMER][NEUTRAL] OK, so according to this plan, only $25 are allowed for the office visit per day.
[AGENT][NEUTRAL] Right, yes.
[CUSTOMER][NEUTRAL] OK. Remaining is the patient responsibility.
[AGENT][NEUTRAL] We don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I have the claim number?
[AGENT][NEUTRAL] Yes, that is 3541743.
[CUSTOMER][NEUTRAL] OK. May I know how the claim was paid?
[CUSTOMER][NEUTRAL] The 22 $25?
[AGENT][NEUTRAL] It was a
[AGENT][NEUTRAL] Yes, it was a paper check. If you'll give me one moment I can get that information for you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, uh, are you ready for the claim or the excuse me, the check number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That is 2018602.
[CUSTOMER][NEUTRAL] Sure, ma'am?
[AGENT][NEUTRAL] This was issued [PII] and I am showing it has not cleared so I can get this voided and reissued um whenever you're ready let me verify the address that we've got to send this to.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so we've got [PII], is that correct?
[CUSTOMER][POSITIVE] Yeah. Yeah, correct.
[AGENT][NEUTRAL] OK, OK, so I will go ahead and get those checks voided and reissued um did you have any other questions for me?
[CUSTOMER][NEUTRAL] No. So the previous check is single check or bulk check?
[AGENT][NEUTRAL] It's single check.
[CUSTOMER][NEUTRAL] OK, so that check will be voided and they will issue the new check, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. May I know the claim received date and processed it?
[AGENT][NEUTRAL] Yes, one moment.
[AGENT][NEUTRAL] So this checkers received [PII] and it was processed excuse me, [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Can you fax me the UOB?
[AGENT][POSITIVE] Absolutely. What was that fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I need the UOB for 33 claims.
[AGENT][NEUTRAL] OK, I'm gonna read
[AGENT][NEUTRAL] OK, let me read that fax number back to you, make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and it would just go to your attention?
[CUSTOMER][NEUTRAL] Attention to my name, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, I will get that sent to you. Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I need the UBS for the previous two claims also.
[AGENT][POSITIVE] OK, OK, I will get those sent to you as well.
[CUSTOMER][NEUTRAL] Yeah. May I know the turnout and time to get the U?
[AGENT][NEUTRAL] Um, yeah, I'll get them sent now. It should take, uh, maybe about 10-15 minutes depending on how busy your machine is.
[CUSTOMER][NEUTRAL] Yeah, thank you. Can I have the call reference number?
[AGENT][NEUTRAL] Of course, reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] Last initial is [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] No, thank you for your assistance. Have a great day, but don't forget to send the OB.
[AGENT][NEUTRAL] Of course, and she can APL, of course.
[AGENT][POSITIVE] Alright thank you bye bye.
[CUSTOMER][NEUTRAL] Right