AccountId: 011433970860
ContactId: 5a7ebdab-9160-4ea1-809f-73738a29294a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 364040 ms
Total Talk Time (AGENT): 143555 ms
Total Talk Time (CUSTOMER): 89214 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/5a7ebdab-9160-4ea1-809f-73738a29294a_20250130T19:27_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII] speaking. How can I help you?
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Are you able to hear me?
[CUSTOMER][NEUTRAL] I, I'm audible.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you for calling APL.
[CUSTOMER][NEUTRAL] Uh huh, this is.
[AGENT][NEUTRAL] This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] I'm looking for the demand status for Pasheet.
[AGENT][NEUTRAL] So you need a claim status?
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] I can help you with the claim status. Can I have your first name please?
[CUSTOMER][NEUTRAL] Sure, it was [PII] and the last name initial was [PII].
[AGENT][NEUTRAL] And where are you calling from today, [PII]?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] Uh, the name of the provider, please.
[CUSTOMER][NEUTRAL] So, just a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Provider name is Kendal Anesthesia Associates and the impact for this provider would be 190219-0838.
[AGENT][POSITIVE] Thank you [PII] and may I please have a callback number in case we get disconnected and I may call you back.
[CUSTOMER][NEUTRAL] Sure, the best callback number would be [PII] and it's a direct line with no extension.
[AGENT][NEUTRAL] Thank you and [PII], may I please have the policy certificate or member ID?
[CUSTOMER][NEUTRAL] Sure. The member ID number would be 02509837. Patient name is [PII], and the date of birth for this number was [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My claim details for this was.
[CUSTOMER][NEUTRAL] And 11 of 2024 with the total charges of $940 even.
[CUSTOMER][NEUTRAL] And I do have a claim number as well.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, you can go ahead and provide me that claim number when you're ready.
[CUSTOMER][NEUTRAL] Sure. It was 351-542-2.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And just give me a moment to uh look at that claim please.
[AGENT][NEUTRAL] I'm gonna pull the claim image.
[AGENT][NEUTRAL] Just bear with me for one moment please.
[CUSTOMER][NEUTRAL] Or take your time.
[AGENT][NEUTRAL] $940 911 2024 that claim number 3515422. Uh, we received that claim, yeah, we received the claim on [PII] process date is [PII]. It looks like we're requesting the primary insurance explanation of benefits. This policy is secondary.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Yeah that's right.
[CUSTOMER][NEUTRAL] And may I know who is primary for the patient?
[AGENT][NEUTRAL] Let me see if I have that information.
[AGENT][NEUTRAL] It doesn't look like I have that information in the system as to what their primary insurance is, but this policy is uh a supplemental secondary plan and does require them to have primary insurance in place in order to take this policy out.
[CUSTOMER][NEUTRAL] Uh-huh. I
[CUSTOMER][NEUTRAL] Oh, thank you for this information. And uh may I know when was the last call updated by the patient?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] When was the last call updated coordination of benefits?
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I'm not certain of that. I don't have that information when we don't, it's not a it's not a coordination of benefits necessarily because this policy again is limited supplemental benefit plan so again they do have to have primary insurance in place um to take this policy out um it looks like it could be a um uh uh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] AvMed HMO.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] But I do not have that uh specific information um in my system, so I'm not sure who their primary is. You may need to contact the patient to obtain that information.
[CUSTOMER][NEUTRAL] A [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Sure, thank you for this information. And uh could you please spell out your good name?
[AGENT][NEUTRAL] Yes, would you like our fax number to fax your claim, or you have to uh uh send it to primary insurance first?
[CUSTOMER][NEUTRAL] Uh, we will be sending the claim for primary insurance first by contacting the member.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, alright, so your call reference number you would use my name in today's date, [PII], my first name [PII]
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Last initial [PII]
[AGENT][POSITIVE] Like love.
[CUSTOMER][NEUTRAL] Today, today's date, right?
[AGENT][NEUTRAL] That's right, mhm, did you have any other questions?
[CUSTOMER][NEUTRAL] For this information.
[CUSTOMER][POSITIVE] And have a wonderful day. Bye for now.
[AGENT][POSITIVE] Thank you [PII] Thank you for calling API. You have a great day as well. Bye bye.