AccountId: 011433970860
ContactId: 6ebce120-1434-40aa-8735-5a55f7a01c3c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 509940 ms
Total Talk Time (AGENT): 147230 ms
Total Talk Time (CUSTOMER): 231563 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/6ebce120-1434-40aa-8735-5a55f7a01c3c_20250522T16:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, uh, good afternoon. My name is [PII]. I'm an agent and I'm following up regarding some claims that we had submitted for one of our members.
[AGENT][NEUTRAL] I'm sure [PII], I can assist you with client status. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Oh absolutely area code [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Uh, policy number is 1957221.
[CUSTOMER][NEUTRAL] And the primary insured's first name is [PII]. Last name is [PII], and I've got the claims for her two dependents.
[AGENT][NEUTRAL] OK. And what's her date of birth?
[CUSTOMER][NEUTRAL] And I do have the claim numbers that are on file. Uh, the mom's date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And the first dependent, I'll need her name and date of birth.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure, uh, first name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[CUSTOMER][NEUTRAL] And we have a claim number.
[CUSTOMER][NEUTRAL] 359.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 693 1
[CUSTOMER][NEUTRAL] And that was a data service uh looks like their office visits.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, yes, sir. We received that claim on [PII]. It processed on [PII].
[AGENT][NEUTRAL] Um, it, it paid out for $75 even.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, paid 75. OK, perfect. And then, uh, I guess and then the next one, for the same person next is claim number 3596959.
[AGENT][NEUTRAL] OK, we received this claim on [PII] and it processed on [PII].
[AGENT][NEUTRAL] It paid out for $25.
[CUSTOMER][NEUTRAL] OK, page 25 perfect and next one that we have on her uh claim number 359-6969.
[AGENT][NEUTRAL] OK, received [PII], processed on [PII]. It paid out for $50.
[CUSTOMER][NEUTRAL] OK the 150.
[CUSTOMER][NEUTRAL] OK, and then the last one for her is 359-699-2.
[AGENT][NEUTRAL] OK. Received on [PII], processed on [PII]. It paid out for $25.
[CUSTOMER][NEUTRAL] A 25 OK and then the last one is now on her brother and hold on one second, this is uh [PII].
[CUSTOMER][NEUTRAL] And his date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And claim number is showing as 359-9467.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] OK, I'm showing that this claim was received on [PII]. It processed on [PII]. And it's actually denying because we need the diagnosis code. Um, the claim can be resubmitted with that information. We just need documentation from the provider's office with a diagnosis code that can be resubmitted to have the claim reprocessed.
[CUSTOMER][NEUTRAL] OK, there was the uh diagnosis code on the EOB next to the doctor's name.
[CUSTOMER][NEUTRAL] It was M as in Mary 92.52.
[AGENT][NEUTRAL] OK, one moment. Let me pull the EOB.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] It was on page 3 with the date of service.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, yes, sir. I'm showing that it's on the claims application and we actually would need documentation from the provider's office.
[CUSTOMER][NEUTRAL] From the provider's office.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] So in in regards to what having them what call in or do they let the member know what uh.
[CUSTOMER][NEUTRAL] Or, or do they need a.
[AGENT][NEUTRAL] Um, on the, normally, um, yeah, normally they can get a letter or a statement, just something, um, some documentation from the provider's office with a diagnosis code on there.
[CUSTOMER][NEUTRAL] OK, statement showing diagnosis code. OK, so we need something, OK, showing it. OK, not just verbally saying, OK, showing diagnosis code. OK, OK, perfect. And then, uh, let's see, hold on.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, and I've just updated this one. Can I also trouble you for a separate member under the same group?
[AGENT][NEUTRAL] Sure. What's the policy number?
[CUSTOMER][NEUTRAL] Policy number is 107.
[CUSTOMER][NEUTRAL] 0862.
[CUSTOMER][NEUTRAL] Her first name is [PII]. Last name is [PII].
[CUSTOMER][NEUTRAL] And her date of birth is [PII].
[AGENT][NEUTRAL] OK, and the date of service and bill charges or claim number?
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Uh, yeah, I've got the uh claim number is showing for the first one it's showing as 360.
[CUSTOMER][NEUTRAL] 0820
[AGENT][NEUTRAL] OK, we received this one on [PII]. It processed on [PII], and it paid out for $25.
[CUSTOMER][NEUTRAL] OK perfect and then we have the next one claim number 360.
[CUSTOMER][NEUTRAL] 0854
[AGENT][NEUTRAL] OK. Received on [PII], processed on [PII], and
[AGENT][NEUTRAL] It paid out for $25.
[CUSTOMER][NEUTRAL] Page 25 OK and then the last one is showing as claim number 3600912.
[AGENT][NEUTRAL] OK. Received on [PII], processed on [PII].
[AGENT][NEUTRAL] And it paid out for $25.
[CUSTOMER][POSITIVE] OK awesome thank you so much and I'll go ahead and get the other one updated and I'll have them uh resubmit that then.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, that should be it. Thank you so much.
[AGENT][POSITIVE] OK. Thank you, [PII] for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] You do the same thank you bye bye.
[AGENT][POSITIVE] Mm. You're welcome.