AccountId: 011433970860
ContactId: 6ae4e4ff-1c25-4096-bc11-3680797876bb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 593250 ms
Total Talk Time (AGENT): 146777 ms
Total Talk Time (CUSTOMER): 192901 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/2025/03/18/6ae4e4ff-1c25-4096-bc11-3680797876bb_20250318T20:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Hi, yes, I'd like to check claim status for your patient. My name is [PII].
[AGENT][NEUTRAL] [PII], spell your name for me, please.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and you said you're checking claim status?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Policy number is 0 sorry 0220.
[CUSTOMER][NEUTRAL] 309989 N as in Nancy, L as in Larry 8.
[AGENT][NEUTRAL] 022 0309.
[CUSTOMER][NEUTRAL] Yeah, 89 NL 8.
[AGENT][NEUTRAL] OK, what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] my extension.
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] Last name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] I'm showing a different name for that policy number 02203098.
[CUSTOMER][NEUTRAL] You might
[AGENT][NEUTRAL] The letters before the letter Em.
[AGENT][NEUTRAL] I mean the numbers before the letter N Em.
[CUSTOMER][NEUTRAL] OK, maybe maybe it's her husband that's the policy holder.
[AGENT][NEUTRAL] And what is his name?
[CUSTOMER][POSITIVE] Hi, please, OK, take a seat for a second, please. Thank you.
[CUSTOMER][NEUTRAL] Um, let me just double check.
[CUSTOMER][NEUTRAL] She did send me the card.
[AGENT][NEUTRAL] Reaching me what's on the card. What's the name of the insurance company on the card?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] This thing is being dumb now. I'm sorry.
[AGENT][POSITIVE] Oh, no worries
[AGENT][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] Let's see, OK, yeah, I mean that's what I have here and it's her name. It's not all it's APL, American Public Life.
[AGENT][NEUTRAL] Spell her name for me, first and last.
[CUSTOMER][NEUTRAL] OK, [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], last name is [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the group is 233.
[CUSTOMER][NEUTRAL] 32
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, that's um at the bottom where it says.
[CUSTOMER][NEUTRAL] Maybe OK.
[CUSTOMER][NEUTRAL] It's [PII], I'm sorry, 02203089 M as in.
[CUSTOMER][NEUTRAL] Mom 88 that's for the outpatient.
[AGENT][NEUTRAL] OK. I
[AGENT][NEUTRAL] Yeah, that's fine. I had [PII]. It's actually you said it's 89. OK, I see her now.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, sorry.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] And her date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Alright, and so the, so uh you're checking a claim status for her um what's the data service?
[CUSTOMER][NEUTRAL] Date of service.
[CUSTOMER][NEUTRAL] [PII] total bill amount. I'll tell you that now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah yeah my present.
[CUSTOMER][NEUTRAL] This is, I don't know when you wanna do things faster you can't.
[AGENT][NEUTRAL] Is it, is it an office visit?
[CUSTOMER][NEUTRAL] This is a specialist office. Is it dermatology? The thing is I uh let me change your.
[AGENT][NEUTRAL] What's the name of the practice?
[CUSTOMER][NEUTRAL] Agribelo, PA.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I I'm not been able I'm I'm trying to open up the you'll be that's what I'm doing I'm trying to do now.
[AGENT][NEUTRAL] I see it. Yeah, I see it here.
[AGENT][NEUTRAL] Last name is [PII] Doctor's last name, [PII]? OK.
[CUSTOMER][NEUTRAL] Yeah, so it'll be, yeah.
[AGENT][NEUTRAL] Alright, and so the payment was denied or the claim was denied, the office visit fee is not covered under this policy, and I show that we processed this [PII].
[AGENT][NEUTRAL] And the explanation of benefits was mailed to the address on the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is it possible to get the?
[CUSTOMER][NEUTRAL] Like email the EB.
[AGENT][NEUTRAL] Um, since it's been mailed, it can be downloaded from our online, uh, center. I can give you that address and then help you set the account up to download that, uh, ELB if you would like.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, it's because it's not like everyone has American public life.
[CUSTOMER][NEUTRAL] Um, I'm gonna look, I'm gonna look through my papers if I have the you'll be.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK that's the only way it was mailed you said you say right?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, that's weird.
[AGENT][NEUTRAL] What, what is your, what is your um
[AGENT][NEUTRAL] Fax number.
[CUSTOMER][NEUTRAL] Fax number, yes, fax number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, give me 1 2nd. I wanna verify your address as well. Give me a second.
[CUSTOMER][NEGATIVE] I mean if I if we could receive it through fax because I really need it and the patient's like oh why didn't they cover I'm like well it's it's under offices. I don't think they cover that.
[AGENT][NEUTRAL] Right, yeah, I can fax it to you, but I still want to verify if you didn't receive the ELB I'd just like to verify the date of the, the mailing address, the billing address.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] So it wasn't actually the CMS 100 form that was sent. It looks like it's an EOB. What is, what is the address to this location?
[CUSTOMER][NEUTRAL] Yes, [PII]. That's our office uh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, that's where it was mailed. Give me one second.
[AGENT][NEUTRAL] Still looking
[AGENT][POSITIVE] Alr[PII], it's on its way, you should receive it here shortly.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And I'm sending it to [PII] correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And did you have any other questions, [PII] and I can help out with today?
[CUSTOMER][POSITIVE] No, thank you so much for your patience.
[AGENT][POSITIVE] Oh, you're welcome and no problem and thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah