AccountId: 011433970860
ContactId: 67fba75f-13ba-4a58-a133-7d07c2966bc6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 608330 ms
Total Talk Time (AGENT): 257699 ms
Total Talk Time (CUSTOMER): 132546 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/67fba75f-13ba-4a58-a133-7d07c2966bc6_20250114T15:17_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 [PII], this is [PII] calling from Proto's office. I'm checking on a claim status. Could you help me with that?
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with the claim status. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] With the status and
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And did you say your name was [PII]? I'm sorry.
[CUSTOMER][NEUTRAL] Now did you say your name was
[CUSTOMER][NEUTRAL] No [PII].
[AGENT][NEUTRAL] [PII]? OK. And [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] It is 025.
[CUSTOMER][NEUTRAL] 361997.
[AGENT][NEUTRAL] Thank you for that. How many claims do you have in total today?
[CUSTOMER][NEUTRAL] I have only one claim.
[AGENT][NEUTRAL] All right, and I have the member's policy here. I just need you to verify the date of birth and the first and last name.
[CUSTOMER][NEUTRAL] Oh sorry, I do have two claims for the same patient. Sorry for that.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Uh, one is [PII].
[AGENT][NEUTRAL] Wait a minute. Um, I need the member's first and last name and date of birth first.
[CUSTOMER][NEUTRAL] Wait a minute.
[CUSTOMER][NEUTRAL] Yes, it is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Are both um claims for [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what are the 2 dates of service and the total bills?
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] The date of service is [PII], sorry. It is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the bill amount is for one is $24 and another one is $265 even.
[AGENT][NEUTRAL] Oh, both for [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But I'm not showing any claims on file for [PII] for [PII].
[CUSTOMER][NEUTRAL] We also previously get the claim status your side.
[AGENT][NEUTRAL] OK, do you have a claim number?
[CUSTOMER][NEUTRAL] Yes, I do have that. It is 3521416.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, wait a minute.
[AGENT][NEUTRAL] Wait a minute.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so the claim number that you're giving me is under their medical policy, but you gave me the policy number for their dental policy. So is this for dental or medical because
[CUSTOMER][NEUTRAL] It is for medical.
[AGENT][NEUTRAL] OK, so hold on one moment. Let me go to that medical policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it was October.
[AGENT][NEUTRAL] OK. So this claim was denied um because the medical test for the data service is not a covered diagnostic test. And what questions did you have in reference to the claim?
[CUSTOMER][NEUTRAL] Yes, we did not receive what is the exact detail we know that.
[AGENT][NEUTRAL] The exact details, you mean like the denial reason?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, it's not a covered diagnostic test.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] But if you like, I can fax you over a copy of the explanation of benefits. You said you didn't have one.
[CUSTOMER][NEUTRAL] Yes, we don't have that. Can you send that we?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Yes it is [PII]. You can put my name uh attention, [PII]
[AGENT][NEUTRAL] OK, now it's [PII].
[CUSTOMER][NEUTRAL] No
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, hold on one moment. And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. So I am faxing this over to you now. Hold on one moment.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm. Also, I do have uh another client.
[AGENT][NEUTRAL] OK, hold on one moment, let me, um.
[AGENT][NEUTRAL] So this one is for
[AGENT][NEUTRAL] The $24. Um, let me look for the, the $265 is on medical as well, right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Um, if you don't mind, I'm just gonna place you on a brief hold. I'm gonna go ahead and fax this over to you and then I'll look for the $265 claim, and it's also for [PII], right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, um, hold on one moment. I'm just faxing this over to you, but it's giving me a little problem. Hold on one moment, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I'm like, I know I don't see a claim.
[AGENT][NEUTRAL] It's on base and [PII] not talking to each other?
[AGENT][POSITIVE] Looks like that's what's happening. All righty then, let's see what we can do.
[AGENT][NEUTRAL] 12345678.
[AGENT][NEUTRAL] Oh, what's the data, um.
[AGENT][NEUTRAL] That it was after the [PII].
[AGENT][NEUTRAL] Oh [PII], it's 3 of them.
[AGENT][NEUTRAL] Oh, it is. OK. Um.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] I reckon it was, I reckon. That was my grandma.
[AGENT][NEUTRAL] 1416 is the last four of the claim that oh, I went right to it. You better go ahead girl.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, so [PII].
[AGENT][NEUTRAL] Oops.
[AGENT][NEUTRAL] That [PII].
[AGENT][NEUTRAL] 423949 5100 OK and then.
[AGENT][NEUTRAL] I need to look for.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] 265.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, hello, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. Um, so I have faxed you over the explanation of benefits for the $24 claim and then for the $265 claim, um,
[CUSTOMER][NEUTRAL] um
[AGENT][NEUTRAL] I'm showing this, what did you need like the day it was received and denied or you have that information as well?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, yes, I, I do have that information. I want to cross the claim number is uh 3521417. Is that correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, uh, can you send that EP through fax? It is also same denial.
[AGENT][NEGATIVE] Um, well, it's a different denial of reason, but yes, it's denied.
[CUSTOMER][NEUTRAL] OK, what is the reason of denied?
[AGENT][NEUTRAL] For this claim, the calendar year maximum on diagnostic services has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can you send this you will be fax?
[AGENT][NEUTRAL] Yes, I'm faxing this to you now. I'm just waiting for it to come up here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so this is being faxed over to you now. I'm putting in the number. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, let me get the call reference number for this call.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date. And again, that's [PII]
[AGENT][NEUTRAL] First initial to my last name is [PII], and then today's date.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you for calling this information. That was really helpful. Have a wonderful day.
[AGENT][POSITIVE] You also and thanks for calling APO bye bye.
[CUSTOMER][NEUTRAL] Bye bye.