AccountId: 011433970860
ContactId: 5f6f392e-b89e-407c-ad71-4e7afeb36641
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 542010 ms
Total Talk Time (AGENT): 129208 ms
Total Talk Time (CUSTOMER): 136699 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/5f6f392e-b89e-407c-ad71-4e7afeb36641_20250227T18:22_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, so, this is [PII] calling from provider's office.
[AGENT][NEUTRAL] OK. How may I assist you today, Mr. [PII]?
[CUSTOMER][NEUTRAL] Uh, yeah, so actually previously I, I'm spoke, uh, I spoke with one of your representative and she's going to fax me uh UOB for a claim. I can give you the member ID, but, uh, the call suddenly disconnect. So I want to know if she already sent uh the fax for this claim or not? If, if it is not, uh, so can you please send the fax, uh, for the you for the claim?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I can check and see what happened. And may I have a callback number just in case we get disconnected, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes, [PII] with a direct line.
[AGENT][NEUTRAL] You said it's direct line?
[CUSTOMER][NEUTRAL] Yes, direct line.
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, patient policy number just a moment let me open the claim.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Yeah, the policy number is 01592015.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient name, it's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK. Do you know if the member goes by any other last names besides [PII]?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]
[AGENT][NEUTRAL] Do you have the claim number, Mr. [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] No, I don't have any claim number because I'm it's uh it's first time call for this claim.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so, um, when you call earlier, she didn't provide to you the fax the account number. I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, sorry, sorry, sorry, uh, she gave me that, uh, the claim number was 347749.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 347749.
[AGENT][NEUTRAL] OK, bear with me just a second, let me pull a copy of this AOB.
[AGENT][NEUTRAL] Um, right.
[AGENT][NEUTRAL] Let me look at them now.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, Miss uh [PII].
[AGENT][NEUTRAL] Indicated that she did fax over the claim to you to the fax number [PII].
[CUSTOMER][NEUTRAL] OK, so her name was [PII]?
[AGENT][POSITIVE] Correct, [PII]
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, and she already fax, uh, faxed the UB, right?
[AGENT][NEUTRAL] Yeah, yeah, based on the notes it looks like she faxed that to [PII]. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can you, can you check uh one thing, uh, the claim is paid for $25 right?
[AGENT][NEUTRAL] Um, can you verify the date of uh service and the amount just to make sure I'm looking at the right one.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. bill amount is $332 even for the charges.
[AGENT][NEUTRAL] Mhm. Yes, we did pay $25 which is the maximum payable under this policy.
[CUSTOMER][NEUTRAL] And uh what's the rest amount goes to is it goes to the patient responsibility?
[AGENT][NEUTRAL] It's up to the provider's discretion. We don't have any contractual enrollment on the remaining.
[CUSTOMER][NEUTRAL] OK, OK, I got that. Uh, so, so can you uh confirm one more time, do you guys already fax or not? Uh, can you check your fax, uh, is it already sent over to our fax?
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] I can go ahead and send a message to her to see if she did send it out. I see the note indicating she did, but I can confirm with her if you don't mind holding for me.
[CUSTOMER][POSITIVE] Sure, I'm, I'm, uh, take your time, no problem.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Thank you for holding and being patient for Mr. [PII]. Yes, can you hear me?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][POSITIVE] Yes, I can hear you. Thank you.
[AGENT][NEUTRAL] OK. Yes, Ms. [PII] just sent me a message indicating she did send out the fax.
[CUSTOMER][NEUTRAL] OK. Can you provide me the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] Uh, can you spell out your name, please? [PII]?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] [PII] [PII].
[CUSTOMER][POSITIVE] OK. Thank you, thank you for the information.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] Uh, no, just thank you, thank you for the information.
[CUSTOMER][NEUTRAL] Buy a ticket.