AccountId: 011433970860
ContactId: 5f3aad24-58a1-4faa-a6d1-4987992f54c0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 825289 ms
Total Talk Time (AGENT): 264915 ms
Total Talk Time (CUSTOMER): 223600 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/5f3aad24-58a1-4faa-a6d1-4987992f54c0_20250128T16:57_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. Uh, good afternoon. My name is [PII] and last term in insurance for Nancy. I'm calling from provider's office regarding claim status.
[AGENT][NEUTRAL] OK, yeah, I could check on a claim for you [PII]. Can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. [PII]. It is a direct line.
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah. It's 0234 0652 M for Mary, L for Lima, 8.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And uh what was the name and date of birth for the member?
[CUSTOMER][NEUTRAL] Yeah, the patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII], what was the date of service for this claim, please?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total charge is $237 even.
[AGENT][POSITIVE] OK, got it. Thank you. One moment, please.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Can, can you spell your name?
[AGENT][NEUTRAL] Uh, my name is [PII]
[CUSTOMER][NEUTRAL] It's [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yeah, thank you, [PII].
[AGENT][NEUTRAL] Of course. One moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I did find this claim, [PII], uh, we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK. And when the claim is denied it?
[AGENT][NEUTRAL] Yes, this claim was received [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] OK. And may I have the claim number?
[AGENT][NEUTRAL] Claim number is 346 8.
[AGENT][NEUTRAL] 959.
[CUSTOMER][NEUTRAL] Thank you. And can you please send any your through fax?
[AGENT][NEUTRAL] Of course, what was that fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm going to read that back, make sure I heard that correctly. That was [PII].
[CUSTOMER][POSITIVE] Yes, it's right.
[AGENT][NEUTRAL] OK, and I just put this to your attention, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, alright, I will go ahead and get that sent to you now. Uh, should get it here in maybe 10-15 minutes depending on how busy your machine is. Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Uh, and a few more members are there. Let's move to another patient.
[AGENT][NEUTRAL] Uh, this is they are for different members?
[CUSTOMER][NEUTRAL] That's a different members.
[AGENT][NEUTRAL] OK, yes, give me just a moment let me get this uh fax sent to you. I'll let you know when I'm ready to proceed.
[CUSTOMER][POSITIVE] Yeah, sure, sure. Take your own time.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][POSITIVE] You're most welcome.
[CUSTOMER][NEGATIVE] So stupid.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Appreciate your patience, [PII]. I'm ready for that next uh policy number when you are.
[CUSTOMER][NEUTRAL] Yeah. Um, the policy number is 1449321 M for Mary, L for Lima 5.
[AGENT][NEUTRAL] Thank you and then uh what was the name and date of birth for this number?
[CUSTOMER][NEUTRAL] Uh, it's [PII], and the date of birth [PII].
[AGENT][NEUTRAL] OK, thank you for that. What was the date of service for this one?
[CUSTOMER][NEUTRAL] OK. Um, the date of service is [PII] and the total charge $9 even.
[AGENT][NEUTRAL] 9, OK.
[AGENT][NEUTRAL] Alright, one moment please.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, uh, just to verify this was, uh, you did say [PII] and this was for [PII], correct?
[CUSTOMER][NEUTRAL] [PII] and the dollar amount is $9 only $9.
[AGENT][NEUTRAL] OK, yes, but this was for, uh, [PII] correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, um, so I am not showing that we received that claim, [PII], um, however, this policy did terminate, uh, [PII].
[CUSTOMER][NEUTRAL] OK, 1 2nd.
[AGENT][NEUTRAL] I did check to see if they had one that was more active um but they do not this was the only policy they had with us.
[CUSTOMER][NEUTRAL] So it was
[CUSTOMER][NEUTRAL] OK. May I know the effective date?
[AGENT][NEUTRAL] Effective date was [PII].
[CUSTOMER][NEUTRAL] And terminated on?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, like you, you provided the [PII], so this is the effective date or termination date.
[AGENT][NEUTRAL] That was the effective date for [PII] uh terminated [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I have any other instances?
[AGENT][NEUTRAL] Um, yeah, the last time we received for this number was in [PII], um, but I don't show that they have any other policies with us. This was the only one they had with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, no worries. Let's move to another claim.
[AGENT][NEUTRAL] OK, yes, one moment please I'll let you know when I'm ready.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] OK, alrighty, I'm ready for that next policy number, [PII].
[CUSTOMER][NEUTRAL] Yeah, just give me a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] Actually, my system is suddenly slowed down.
[CUSTOMER][NEUTRAL] It's loading.
[AGENT][POSITIVE] Sure, no worries.
[CUSTOMER][NEUTRAL] Yeah. Thank you for understanding. And the next one is 02462085 M for Mary, L for Lima, 8.
[AGENT][NEUTRAL] Thank you and then uh what was the name and date of birth for this number?
[CUSTOMER][NEUTRAL] OK. Uh, it's uh.
[CUSTOMER][NEUTRAL] [PII] and the date of birth [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that and uh uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII] and the total charge is $250 even.
[AGENT][NEUTRAL] OK, [PII] for $250.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Yes, sure.
[AGENT][NEUTRAL] OK, so we did receive this claim, [PII], uh, we were unable to pay this benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK. And when the claim received it and denied it?
[AGENT][NEUTRAL] Yes, so this claim was received [PII].
[AGENT][NEUTRAL] Of [PII].
[AGENT][NEUTRAL] And it was processed to [PII] as well.
[CUSTOMER][NEUTRAL] May I know the claim number?
[AGENT][NEUTRAL] Claim number is 353-6224.
[CUSTOMER][NEUTRAL] Thank you. And also, can you please send any of the fax?
[AGENT][NEUTRAL] Uh, yes, one moment please.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK. I will get that sent to you, [PII]. Um, did we have any other claims we needed to look at?
[CUSTOMER][NEUTRAL] And one more claim, that is the last one, OK?
[AGENT][NEUTRAL] OK, yeah, one moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alrighty, I'm ready for that last policy number.
[CUSTOMER][NEUTRAL] Yeah, just give me a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] Actually, suddenly my system is slowed down.
[AGENT][POSITIVE] No, you're perfectly fine. Mine was really slow earlier.
[CUSTOMER][NEGATIVE] Like both sides like both systems are not working properly, right?
[AGENT][NEGATIVE] Freezing up and everything.
[AGENT][NEUTRAL] I know I thinks it's Monday.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] So we lazy systems also lazy.
[AGENT][NEUTRAL] It matters us, doesn't it?
[CUSTOMER][NEUTRAL] 1976. Yeah, one second, I got it.
[CUSTOMER][POSITIVE] OK. Thank you for your patience. And the last one.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, it's open. And the last one is 02286211 M for Mary, L for Lima, 8.
[AGENT][NEUTRAL] OK, thank you and then uh what was the name and date of birth for this number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that and then uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total charge is $237 even.
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] I'm sorry, that was $237 is that right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so this claim is the same as the others, [PII], as we were unable to pay a benefit, uh, office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK. When the claim received it and processed it.
[AGENT][NEUTRAL] Yes, this claim was received [PII], and it was processed to [PII].
[CUSTOMER][NEUTRAL] OK. May I have the claim number?
[AGENT][NEUTRAL] Did you need this EOB faxed to you as well?
[CUSTOMER][NEUTRAL] Yeah. And can you please provide the claim number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, the claim number is 353-634-9.
[CUSTOMER][POSITIVE] Yeah, thank you, [PII].
[AGENT][NEUTRAL] Of course and you did want this faxed to you as well?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I will get that sent to you um was there anything else I could help you with [PII]?
[CUSTOMER][NEUTRAL] Uh, no thanks, [PII]. And may I have the call reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial and today's date, uh, so my last initial is A.
[CUSTOMER][POSITIVE] Yeah, thank you.
[AGENT][POSITIVE] Of course, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Yeah, same to you. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.