AccountId: 011433970860
ContactId: 6593b415-a78c-4ac1-b10c-fc9a2ccd979f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 484059 ms
Total Talk Time (AGENT): 200278 ms
Total Talk Time (CUSTOMER): 156967 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/6593b415-a78c-4ac1-b10c-fc9a2ccd979f_20250429T17:38_UTC.wav
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[AGENT][NEUTRAL] Good afternoon, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, hi, this is [PII] calling from provider's office to check on claim status.
[AGENT][NEUTRAL] OK, I'm sorry, you said your name is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Yeah. Yes, correct. [PII] uh.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] There
[CUSTOMER][NEUTRAL] [PII]. My [PII] is [PII]. Could you please spell out your name?
[AGENT][NEUTRAL] [PII], what was your extension again?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you. My name is spelled [PII], and it will also be your reference number, my name, and along with today's date.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Well.
[AGENT][NEUTRAL] And then she said you're needing claim status, is that correct?
[CUSTOMER][POSITIVE] Mhm. Thank you, [PII].
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] Yes, I can help you with that. And then, how many claims do you have to check status on today?
[CUSTOMER][NEUTRAL] Yeah, uh, I have only one client.
[AGENT][NEUTRAL] OK, and what is that member's policy number, please?
[CUSTOMER][NEUTRAL] Yeah, it's 01227648.
[AGENT][NEUTRAL] OK, thank you one moment while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] And [PII], any information that I provide today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] information.
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEGATIVE] Yeah I didn't wanna do this.
[AGENT][NEUTRAL] Mhm. And his date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] It.
[AGENT][NEUTRAL] And what is the date of service and total bill amount please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's [PII] with the total bill amount of $577 even.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so on this policy, and there is no claim on file for that data service this policy was not active.
[AGENT][NEUTRAL] This policy had an effective date of [PII].
[AGENT][NEUTRAL] And it turned [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There is another policy that is active that you need to have the correct policy number for.
[CUSTOMER][NEUTRAL] OK, but I
[AGENT][NEUTRAL] And that policy number is 0256.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 8956.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that policy is active with an effective date of [PII]. So give me a moment to get that policy information pulled up to see if we process the claim under the correct policy number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Sure, but I have received an uh uh EOB. In the EOB I have an uh claim number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. OK, so on the EOB though, if you have that, you will notice that the policy number you gave me is not the correct policy number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The policy number is going to be what I just gave you on that explanation of benefits.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you see that?
[CUSTOMER][NEUTRAL] Mhm yeah.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] On the.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and then, um, the claim number that you should have is 356-4407.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that claim was denied.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the reason for the denial is that office visits are not covered by this policy. The members supplemental policy does not cover office visits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, in this, uh, in this plan for, uh, what should I need to do for the further
[AGENT][NEUTRAL] We do not determine patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And for future reference, um, I mean should you ever need a copy of an explanation of benefits on a claim that we have processed, I know that you have this one, but you can also print the explanation of benefits directly from our portal, and the website for that is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Um, and, uh, we can appeal or we can send claim for this one.
[AGENT][NEUTRAL] What are you asking me?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, yes, I'm asking so we can send an uh pill, right? We can appeal this.
[AGENT][NEUTRAL] An appeal must be filed within 180 days from the date of the decision.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it would be mailed to the same address as claims and put to attention appeals department.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, thank you so much. Can I get the call reference number?
[AGENT][NEUTRAL] Your, yes, as I mentioned to you before, it would be my name along with today's date.
[CUSTOMER][NEUTRAL] Uh-huh, yes, sorry, I, I just forgot it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, thank you. Thank you so much for this information. That's all from my end. Have a good day. Bye-bye. Take care.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. Well, I hope you have a nice day too, and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][POSITIVE] Uh, I'm buying
[AGENT][NEUTRAL] Hey honey, when did you say those protein shakes were expiring?
[AGENT][NEUTRAL] May, OK, OK, OK.
[AGENT][NEUTRAL] Am I still connected? Of course.