AccountId: 011433970860
ContactId: 62fdc008-d878-4e30-9140-9fab17666102
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 292059 ms
Total Talk Time (AGENT): 115362 ms
Total Talk Time (CUSTOMER): 92837 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/62fdc008-d878-4e30-9140-9fab17666102_20250117T15:23_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I am calling from Fairview Clinics. I'm looking to just confirm details on a claim status. It is for a, um, technically a member with 90 degree benefits, but I keep getting transferred back and forth, and they did say that this one is an APL claim, so just.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Heads up with that because I don't have their their APL ID number.
[AGENT][NEUTRAL] All right, well I can, right.
[AGENT][NEUTRAL] OK, do you have their social?
[CUSTOMER][NEUTRAL] Um, let me see. I might have that. Yes, I do have that. That is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Um, yes, that is [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, that's it.
[AGENT][NEUTRAL] And can you verify the member's first and last name? I just want to make sure I'm in the correct place.
[CUSTOMER][NEUTRAL] Yeah, uh, that's [PII].
[AGENT][NEUTRAL] OK, yes, this is her. Hold on one moment.
[AGENT][NEUTRAL] And um, which policy would this be for?
[CUSTOMER][NEUTRAL] Um, what are my options to answer that question?
[AGENT][NEUTRAL] Like medical, dental.
[CUSTOMER][NEUTRAL] Oh, medical, yes, yeah, medical.
[AGENT][NEUTRAL] OK, and can you verify her date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And um may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] [PII], so it would be [PII].
[AGENT][NEUTRAL] OK, hold on one moment she has.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I just pulled up the first one that I see, but that one termed, so this one. OK, so her active policy number is 245-0818.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm going to look on there for the claim. Hold on one moment.
[AGENT][NEUTRAL] OK, that's laps too, but it was active on the data service. OK.
[AGENT][NEUTRAL] And what is the total bill for the claim?
[CUSTOMER][NEUTRAL] $497 even.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And the claim number is 352.
[AGENT][NEUTRAL] 1016.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim a total of $75.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And did you need that check information?
[CUSTOMER][POSITIVE] Got it. I think that's OK. I think I do have that. I just wasn't able to track which one goes where, so that's perfect. I do have it 75. There's only one for that one.
[AGENT][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] Got it. And then the remaining balance on it, is there any patient responsibility or um just the provider write off?
[AGENT][NEUTRAL] Um, so we don't determine patient responsibility because we're not a major medical insurance company. Um, so for that it would be up to the provider or primary.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Mhm OK.
[CUSTOMER][POSITIVE] Sounds good. OK, I think.
[CUSTOMER][NEUTRAL] That is all I needed then unless you have a call reference number otherwise that should be it.
[AGENT][NEUTRAL] All right, so there's no call reference number, but you can use my name in today's date. So that's [PII] The first [PII] to my last name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect, got it, thank you.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. I hope you have a great day and a great weekend.
[CUSTOMER][POSITIVE] You too thank you bye.
[AGENT][POSITIVE] You're welcome.