AccountId: 011433970860
ContactId: 59cae02f-bc59-440d-9e48-e421c78f30c3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 301799 ms
Total Talk Time (AGENT): 122754 ms
Total Talk Time (CUSTOMER): 119417 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/59cae02f-bc59-440d-9e48-e421c78f30c3_20250509T16:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, uh, good afternoon, I was calling, uh, regarding a member eligibility please.
[AGENT][NEUTRAL] OK, I can help you with the eligibility of a patient. May I please get your name and your callback number and the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] It's [PII] and call back number is [PII] and the facility is Retina Specialist of Alabama.
[AGENT][NEUTRAL] OK, thank you. And then what is um the member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII]'s date of birth [PII], policy number 0197235ML8.
[AGENT][POSITIVE] OK, thank you, Ms. [PII]. I'm gonna pull that policy up for us real quick.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] Let me repeat the policy number to you. The policy number is 0197235ML6 you said?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, let me repeat it. I'm sorry, OK, because I thought I heard a, a, a missed number 019.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 72935 then ML 8.
[AGENT][NEUTRAL] OK, thank you, let me look that up.
[AGENT][NEUTRAL] OK, um, this policy for [PII] is no longer active. The policy did terminate on [PII].
[AGENT][NEUTRAL] But I'm checking to see if he has an active policy, and he does let me give you the good policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You just let me know when you're ready.
[CUSTOMER][POSITIVE] I'm, I'm ready.
[AGENT][NEUTRAL] OK, it's 251-972-4.
[CUSTOMER][NEUTRAL] OK, and when did it become active?
[AGENT][NEUTRAL] The effective date of this one is [PII] and the policy is current.
[CUSTOMER][NEUTRAL] OK, [PII], let let's see.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, because we had claims sent after that after uh August.
[CUSTOMER][NEGATIVE] That we never received a payment on.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, do you know what the data services and the charge amount and I can check the claim for you.
[CUSTOMER][NEUTRAL] OK, I have 3 of them if you don't mind, uh, the first one is 9 1924.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the bill amount is $4,561.
[AGENT][NEUTRAL] OK, and then what's the um amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] OK, one second, it does not appear, well, the primary hasn't paid because there was an authorization issue, so that's probably why the claim hasn't crossed over.
[AGENT][NEUTRAL] OK, alright, well what I'm gonna do is I'm gonna try to look this claim up for you. We're gonna go one at a time I'm gonna put you on a quick hold while I search this claim and I'll be right back with you, Ms. [PII]. Thank you, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. Mhm.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, Ms. [PII], looking on that data service of [PII], I do not find the claim on file.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and that's gonna probably be the reason for the other two because the primary has not paid on the claims.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, and, and may I have your name, you know, a reference number again please? I'm sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am. Um, my name is [PII], and you can use my name and today's date for your reference.
[CUSTOMER][POSITIVE] OK, and I thank you so very kindly.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. I hope you have a blessed weekend and thank you for calling APL.
[CUSTOMER][POSITIVE] You too. Thank you. Bye bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.