AccountId: 011433970860
ContactId: 68e96905-c5df-468a-99e1-9b9906a8c946
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 460029 ms
Total Talk Time (AGENT): 131712 ms
Total Talk Time (CUSTOMER): 144087 ms
Interruptions: 3
Overall Sentiment: AGENT=1.1, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/68e96905-c5df-468a-99e1-9b9906a8c946_20250324T18:49_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] Hi, this is [PII] calling with facility to check on claims.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Did you say that your name is [PII]?
[CUSTOMER][NEUTRAL] Can you hear me?
[CUSTOMER][POSITIVE] That's correct, [PII].
[AGENT][NEUTRAL] I, I can now, [PII], and you're needing claim status, [PII], is that correct?
[CUSTOMER][POSITIVE] That's correct. You got it.
[AGENT][POSITIVE] Yes, I can help you with that. Um. What is your callback number?
[CUSTOMER][NEUTRAL] Callback number is [PII] direct line.
[AGENT][NEUTRAL] Thank you. And how many claims [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] Just one.
[AGENT][NEUTRAL] OK, and what is that member's policy number, please?
[CUSTOMER][NEUTRAL] The Member policy ID is 02298999 Mike Lima 8.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[AGENT][NEUTRAL] And [PII], any information that I do provide.
[AGENT][NEUTRAL] For you 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] The patient name is [PII], not last name is [PII] Date of birth, [PII].
[AGENT][NEUTRAL] Thank you. And the date of service and total bill amount, please.
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] [PII], that is the date range.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And total bill is 166,000.
[CUSTOMER][NEUTRAL] $387.85.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK. So this claim has been received more than once. [PII], the most recently received claim was denied as a duplicate. Do you need the original claim number?
[CUSTOMER][POSITIVE] Mhm. Yes, you can help me with that.
[CUSTOMER][NEUTRAL] I just have an additional question on this claim.
[AGENT][NEUTRAL] Do you already have that, [PII]?
[AGENT][NEUTRAL] I'm sorry, I thought you needed status. Yes. How can I help you?
[CUSTOMER][NEUTRAL] Mm, just a second.
[CUSTOMER][NEUTRAL] Yeah, as I check the initially the claim was denied for because you were requesting the Prime GUB, the Medicare UB for this. Yeah, and we have sent uh
[AGENT][NEUTRAL] That is
[AGENT][NEUTRAL] Primary insurance, the private major medical insurance.
[CUSTOMER][NEUTRAL] Yeah, primary insurance.
[CUSTOMER][NEUTRAL] Yeah, primary insurance, you'll be requested from your side. So we will send this uh primary you will be through fax on [PII].
[AGENT][NEUTRAL] OK, so it appears that there is something that was received on the [PII] that is in line for.
[AGENT][NEUTRAL] Review, but that has not yet been reviewed. Let me see if that is the explanation of.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] We see, let me look at something that would
[CUSTOMER][NEUTRAL] So you have received the primary uh EV, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Can you hear me OK?
[CUSTOMER][NEUTRAL] Yeah, no, it's audible.
[CUSTOMER][NEUTRAL] So you said you received the prime you right or no?
[AGENT][NEUTRAL] I said I'm checking.
[CUSTOMER][POSITIVE] OK, fine. Thank you.
[CUSTOMER][NEUTRAL] We have sent on [PII], so check accordingly.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] So that has been received and in line for you, but it has not yet been reviewed.
[CUSTOMER][NEUTRAL] So, yeah, OK. Uh, it's under review, right?
[AGENT][NEUTRAL] It was received and it is in line for reviews.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, just a second.
[CUSTOMER][NEUTRAL] In line for review. OK. So how much time we need to allow for this?
[AGENT][NEUTRAL] 7 to 10 business days.
[CUSTOMER][NEUTRAL] OK. Uh, so we need to allow.
[CUSTOMER][NEUTRAL] 7 to 10 business days.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] And then we also have our portal that you can.
[AGENT][POSITIVE] But yes, [PII], we also have a portal in which you should be able to join us as well and our portal website that you can go to is secured.
[CUSTOMER][NEUTRAL] OK, fine.
[AGENT][NEUTRAL] [PII] and that is a self-registering portal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can you help me with the um reference number for this call?
[AGENT][NEUTRAL] My name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] Your name, please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, I see. Thank you so much. Bye for now.
[AGENT][POSITIVE] Uh huh, you're very welcome. So is there anything else that I can help you with?
[CUSTOMER][POSITIVE] Thank you so much. Bye for now. That's it.
[AGENT][POSITIVE] Uh-huh. You're welcome. OK, well then, thank you again for calling APO. I hope you have a nice rest of your day.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] Yeah, thank you.
[AGENT][POSITIVE] You're welcome. Bye bye.