AccountId: 011433970860
ContactId: 626e7472-cb60-41a8-9d86-00d66ec44d8f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 818859 ms
Total Talk Time (AGENT): 245217 ms
Total Talk Time (CUSTOMER): 227070 ms
Interruptions: 4
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/626e7472-cb60-41a8-9d86-00d66ec44d8f_20250508T13:03_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from provider's office to check on our clients.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status, [PII]. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Yeah, just one.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yeah, the contact number is [PII]. It's a direct line, no extension. And for the policy number, that is.
[CUSTOMER][NEUTRAL] Just bear with me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Just give me a moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just give me a moment. Let me go on that with your member ID. Actually it's been building the client with your payer ID. That's the mistake on here.
[AGENT][NEUTRAL] OK, I can search the member's policy with their first and last name or their full social. Do you have the claim number?
[CUSTOMER][NEUTRAL] Yeah, I do have the social security number I think so just give me a moment. Uh, it's under the Social Security number [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the member's first and last name?
[CUSTOMER][NEUTRAL] It's uh [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, because I didn't find anything with the social. I'm looking with the first and last name now.
[CUSTOMER][NEUTRAL] Could you please check with the ID number [PII]?
[AGENT][NEUTRAL] Yes, I can try it, but that's not an APL policy number, but I can try it for you. Hold on one moment, let me search by the name.
[AGENT][NEUTRAL] Yeah, so with the name and the social.
[AGENT][NEUTRAL] Nothing's coming up. Um.
[AGENT][NEUTRAL] This one is similar 5.
[AGENT][NEUTRAL] Are the last four digits [PII] or [PII]?
[CUSTOMER][NEUTRAL] You mean, uh,
[CUSTOMER][NEUTRAL] The social security number?
[AGENT][NEUTRAL] Yes, it's the last [PII] or [PII].
[CUSTOMER][NEUTRAL] Just give me a moment.
[CUSTOMER][NEUTRAL] It's under the social security number.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, no that's a different person.
[AGENT][NEUTRAL] OK, now I'm trying it with this num the member number that you gave.
[AGENT][NEUTRAL] Yeah, but that's not an APL policy number, so nothing's coming up. Um, do you have any uh
[AGENT][NEUTRAL] Other information, um,
[AGENT][NEGATIVE] We don't have enough information.
[CUSTOMER][NEUTRAL] Yeah, I, I just can provide you with the member's date of birth.
[AGENT][NEUTRAL] I can't search with the date of birth. Um, so with the first and last name, the social, and this member ID.
[AGENT][NEUTRAL] Um, nothing is coming up with the member. Let me, let me try this because this is too close. What's the date of birth that you have?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] So what we have here, the last four, yeah, we'll have to get with her for her social and update that if it needs to be corrected, um, but I do have her here. The policy number is 255.
[CUSTOMER][NEUTRAL] Just give me a moment. It's uh 255.
[AGENT][NEUTRAL] 62663.
[CUSTOMER][NEUTRAL] That's the policy number 2556263.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Yes, that's our APO policy number. Um, may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Yeah, just give me a moment.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] We just ask for the NPA number, right?
[AGENT][NEUTRAL] No, I asked for the date of service. Hold on, I asked for the date of service and the total bills.
[CUSTOMER][NEUTRAL] It's 117.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Number 15 and the bill amount is $361 even.
[AGENT][NEUTRAL] OK, so we don't have a claim on file for
[CUSTOMER][NEUTRAL] And can I have the last name initial?
[AGENT][NEUTRAL] Can you please allow me to finish my statement?
[AGENT][NEUTRAL] There's no claim on file for [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, just give me a moment. Let me check on my end whether I can find any other thing, but I just found the, yeah, I just found the insurance you'll be here. Let me check. Let me provide you with the claim number.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Hold on 1 2nd. Hold on 1 2nd.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I see what I did.
[AGENT][NEUTRAL] It's not as oh this one.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] The name of the provider's office that is.
[CUSTOMER][NEUTRAL] Just give me a moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just bear with me a moment.
[CUSTOMER][NEUTRAL] The uh Florida Hospital Physician Club.
[AGENT][NEUTRAL] And this one is.
[AGENT][NEUTRAL] All right. And did you need the original claim or the duplicate status?
[CUSTOMER][NEUTRAL] I was just checking on the delegate one.
[AGENT][NEUTRAL] Alright, so we received it on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 356-883-2.
[CUSTOMER][NEUTRAL] Just give me a moment. Just give me, just give me a moment. Go ahead with the uh claim number, I mean the two ticket claim number you are providing with me.
[AGENT][NEUTRAL] 3
[AGENT][NEUTRAL] 356.
[AGENT][NEUTRAL] 88
[AGENT][NEUTRAL] 32.
[AGENT][NEUTRAL] And on [PII], it was denied as a duplicate.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because the original claim was paid.
[CUSTOMER][NEUTRAL] Original claim paid.
[CUSTOMER][NEUTRAL] Just give me a moment.
[CUSTOMER][NEUTRAL] Uh, can I have the original claim number?
[AGENT][NEUTRAL] 354.
[AGENT][NEUTRAL] 2211.
[CUSTOMER][POSITIVE] OK, and that's been got paid on your flight.
[CUSTOMER][NEUTRAL] Let me check on my app. Let me provide you that. Mhm.
[CUSTOMER][NEUTRAL] May I know when did the original claim was submitted? Is it submitted on [PII]?
[AGENT][NEUTRAL] We received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII].
[CUSTOMER][NEUTRAL] But got paid by your.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Go ahead, I was just giving you the claim status, you can proceed.
[CUSTOMER][NEUTRAL] Yeah, I was just checking on uh whether the claim got paid or denied because we just voided the claim on our end and we just submitted a new claim.
[CUSTOMER][NEUTRAL] To you, which is not denied a certificate.
[AGENT][NEUTRAL] So we received the claim on [PII].
[AGENT][NEUTRAL] On [PII], we paid out on the claim to the provider a total of $198.36.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Did you need that checking information?
[CUSTOMER][NEUTRAL] Yes, is that a patient responsibility?
[AGENT][NEUTRAL] We don't determine patient responsibility because we're not the major medical.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It was a single check?
[CUSTOMER][NEUTRAL] Got that. Uh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The check number is 201.
[AGENT][NEUTRAL] 8753.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was issued on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the check cleared?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was mailed to [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I got that. Just give me a moment.
[CUSTOMER][NEUTRAL] Sure, we don't found any UB for that. Could you please send us a copy of uh UB through fax for the one, I mean, for the original. It's [PII].
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[AGENT][NEUTRAL] And do I need to pay attention, [PII]?
[CUSTOMER][NEUTRAL] No, no attention requests.
[AGENT][NEUTRAL] And it's [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I'm gonna go ahead and send that over to you now. Was there anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] No, just a card reference number.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. First initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Can I
[CUSTOMER][POSITIVE] Yeah, thank you.
[CUSTOMER][POSITIVE] Thank you for that.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][POSITIVE] Alrighty, well thank you for calling API.