AccountId: 011433970860
ContactId: 68f5670c-fe54-4487-9fdf-40edca296707
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 670780 ms
Total Talk Time (AGENT): 193780 ms
Total Talk Time (CUSTOMER): 116777 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/68f5670c-fe54-4487-9fdf-40edca296707_20250327T13:31_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, this is [PII] calling from provider office to check on claim status.
[AGENT][POSITIVE] OK, well I'll be more than happy to help you with the claim status, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, just a moment, please.
[CUSTOMER][NEUTRAL] Yeah, it's uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] How many claims do you have in total today?
[CUSTOMER][NEUTRAL] One
[AGENT][NEUTRAL] Alright, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. It's 8, sorry, it's 02492690.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, my first name is [PII] and the last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Uh, it's $121.25 and total bill amount is uh $216.00.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, it's uh
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] The the facility name?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, what's the tax ID?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Alright, thank you for that. And I'm showing we received the claim on
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I want
[CUSTOMER][NEUTRAL] OK. It's uh received on [PII]. OK.
[AGENT][NEUTRAL] Actually,
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the insured submitted this claim, so we won't be able to give claim status um because it's not a provider claim.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The insured, the patient.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] I'm here. The patient submitted.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, yeah, tell me.
[AGENT][NEUTRAL] The patient submitted the claim?
[AGENT][NEUTRAL] So we are unable to give you as the provider their claim status. Had you submitted the claim, we would be able to give the claim status, but since the patient did, we cannot.
[CUSTOMER][NEUTRAL] Uh, thing is actually we have, uh, previously on, uh, once again.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, please on [PII], uh we are all, we are rece the claim status, uh, what we have to know whether you pay to patient with uh check or EFT.
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] On [PII], we received, sorry, can you hear me?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Actually, on [PII], uh the patient, the claim status has been received from you and uh whether it is paid to patient through EFTR check.
[AGENT][NEUTRAL] It was
[AGENT][NEUTRAL] So we're, we're not going to give that information. It was paid to the patient.
[CUSTOMER][NEUTRAL] I don't
[CUSTOMER][POSITIVE] Yeah, it's better to patient.
[AGENT][NEUTRAL] And when you, when they called on the [PII], the claim hadn't been processed all the way. We were waiting for tax information from the provider and we advised them that the insured had been paid on that day too. So we cannot give that claim status because it belongs to the insured.
[CUSTOMER][NEUTRAL] So you are telling that you can provide the details, uh, it's because uh it's been uh submitted by patient.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Alright, just give me a moment please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Hi, thank you for being on line.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK. Actually, as by my uh checking, claim has been submitted by your husband not by patient.
[AGENT][NEUTRAL] So, when the claim was originally received, there was an issue with the tax information. So we sent you what's called a B notice. When that happened, we paid the claim to the patient, not saying that the patient submit submitted it, it was paid to the patient. So once we receive the tax information from you all, we then process the claim fully.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, OK.
[AGENT][NEUTRAL] So the payment was made to the insured.
[CUSTOMER][NEUTRAL] Oh, OK. There is a tax ID. Uh, can you please repeat that why the patient, it's been paid to patient?
[CUSTOMER][NEUTRAL] I need to document it so.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm just waiting for it to come up.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] We sent you all an explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] stating that we are unable to
[CUSTOMER][NEUTRAL] Once again.
[CUSTOMER][NEUTRAL] Staving
[AGENT][NEGATIVE] We are unable.
[AGENT][NEUTRAL] To assign benefits to the provider.
[AGENT][NEUTRAL] Of record
[AGENT][NEUTRAL] Due to a discrepancy?
[AGENT][NEUTRAL] With the provider's tax ID number.
[AGENT][NEUTRAL] A letter has been mailed.
[AGENT][NEUTRAL] To the provider with instructions.
[AGENT][NEUTRAL] On resolving the discrepancy.
[AGENT][NEGATIVE] The provider will need to resolve the discrepancy.
[AGENT][NEUTRAL] With our office.
[AGENT][NEUTRAL] To resume receiving communications.
[AGENT][NEUTRAL] Regarding claim decisions and benefit payments.
[AGENT][NEUTRAL] Our claim decision.
[AGENT][NEUTRAL] Including any payable benefits.
[AGENT][NEUTRAL] For this charge,
[AGENT][NEUTRAL] Has been sent to the insured.
[AGENT][NEUTRAL] And then it says, please contact our office with any questions.
[CUSTOMER][POSITIVE] OK, thank you for the information.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] One second please.
[CUSTOMER][NEUTRAL] The letters
[CUSTOMER][NEUTRAL] OK, can you please provide the call reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date, and the first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you for the information, [PII]. Have a nice day. Bye bye.
[AGENT][NEUTRAL] You also, [PII], was there anything else I can help with?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] Alright, thanks for calling APO bye bye.