AccountId: 011433970860
ContactId: 6eacab57-4086-4e12-9655-8323ee09ea25
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 523020 ms
Total Talk Time (AGENT): 178550 ms
Total Talk Time (CUSTOMER): 189834 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/6eacab57-4086-4e12-9655-8323ee09ea25_20250110T14:14_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII]. May I have the claim status for one please?
[AGENT][NEUTRAL] I'm sorry, I can't understand you.
[CUSTOMER][NEUTRAL] Hello, [PII]. I'm [PII] calling from MRElining regarding the claim.
[AGENT][NEUTRAL] Yeah, OK, what was your name?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII], last name initial is [PII].
[AGENT][NEUTRAL] OK, thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[AGENT][NEUTRAL] Thank you. And did you say that you were needing claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I can help you with that, [PII]. And how many twins do you have?
[CUSTOMER][NEUTRAL] I have only one claim.
[AGENT][NEUTRAL] OK, what is that member's policy number, please?
[CUSTOMER][NEUTRAL] Uh, policy number is
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Hold on. 02419274.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] OK, and [PII], any information that I provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And what was the first name again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Uh, the size is [PII] for the day, uh, bill amount $7969 even.
[AGENT][NEUTRAL] OK, give me the date of service and the bill amount again.
[CUSTOMER][NEUTRAL] [PII]. The amount is $769 769.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so, uh, let's see, [PII], just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I do not have a claim on file for him for that date of service and total bill amount.
[CUSTOMER][NEUTRAL] OK. You should be, uh, you entered there is.
[CUSTOMER][NEUTRAL] 318 2024.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] 318 2024 for 769.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][NEGATIVE] You don't have any cream.
[CUSTOMER][NEUTRAL] Uh-huh. Mm.
[CUSTOMER][NEUTRAL] Can you check on this uh ICN number, check um claim number.
[AGENT][NEUTRAL] You can provide me a claim number, but I will need for the total bill amount to match the claim number that you're giving me. What is the claim number?
[CUSTOMER][NEUTRAL] I'll give you the check.
[CUSTOMER][NEUTRAL] It's 350-4109.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so what is the total bill amount on that claim to APL?
[CUSTOMER][NEUTRAL] 769.
[AGENT][NEUTRAL] OK, that
[CUSTOMER][NEUTRAL] 769.
[AGENT][NEUTRAL] Yes, ma'am, that billed amount on that claim does not match.
[CUSTOMER][NEGATIVE] Uh, that's because, uh, I previously called, uh, to the American public life and connected with, uh, one agent. He, uh, she gave me that claim number and claim details, uh, but promised to, uh, send the EOB to my fax number, but it is not received.
[CUSTOMER][NEUTRAL] That's why I called.
[AGENT][NEGATIVE] OK, but that again, that the dollar amount that you are giving me does not match this claim that was received.
[CUSTOMER][NEUTRAL] That means that
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get the uh patient account number for that uh claim?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can I get it?
[AGENT][NEUTRAL] No, ma'am, you'll need to provide it to me. I, I can't give you that.
[CUSTOMER][NEUTRAL] OK. The um patient account number is [PII] [PII]. Is that the patient account number?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEGATIVE] No, ma'am, it is not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can I verify the uh mailing address?
[AGENT][NEUTRAL] Yes, ma'am. [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] Uh, may I have the time if I limit for in initial claim submission?
[AGENT][NEGATIVE] There is no timely filing.
[CUSTOMER][NEUTRAL] Uh-huh. OK. Uh, can I know if this number is active for the date of service?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Uh, may I have your name one more time?
[AGENT][NEUTRAL] [PII] and my name along with today's date will be your call reference number and also [PII] when the claim is submitted to APL for review.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] We will also have to have a copy of the primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] As well.
[AGENT][NEUTRAL] And then you may also check claim status.
[AGENT][NEUTRAL] And print the explanation of benefits for our company once the review has been completed by going to secured. [PII].
[CUSTOMER][NEUTRAL] Yeah, I checked that portal also.
[AGENT][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] Uh, yeah. Uh, may I have your name now? I mean, uh, can you spell me your name one more time?
[AGENT][NEUTRAL] It is [PII].
[CUSTOMER][POSITIVE] OK. Thank you, [PII], for the details and have a nice day.
[AGENT][POSITIVE] Absolutely.
[AGENT][POSITIVE] Yes, ma'am. If that's all I can help you with, [PII]. Thank you for calling APO and I hope you have a nice weekend as well.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] Uh-huh, thank you. Bye-bye.