AccountId: 011433970860
ContactId: 6ee31f7e-6703-4ee4-a031-6b59956f2678
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 514460 ms
Total Talk Time (AGENT): 199589 ms
Total Talk Time (CUSTOMER): 90949 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/6ee31f7e-6703-4ee4-a031-6b59956f2678_20250212T20:07_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. With whom am I speaking how may I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. Um, I am calling because I have a patient who has a couple of claims, um, that have not been paid yet. So I was just calling to see if you've received them.
[AGENT][NEUTRAL] OK, so I can check the status of those claims for you, [PII], what is a good call back number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and what's the policy number you're calling regarding?
[CUSTOMER][POSITIVE] Um, let me get that pulled up for you. I apologize.
[CUSTOMER][NEUTRAL] OK, um, the policy number is 024554449.
[AGENT][NEUTRAL] OK, give me one moment to get that pulled up and then I'll be able to have you verify some information and then I will assist you with the claim status check. What is the member's name and date of birth?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. Verification of coverage does not guarantee the payment of a claim. What is the data service and charge amount you're looking for?
[CUSTOMER][NEUTRAL] Um, there are several dates of service in question, but the first one is [PII].
[AGENT][NEUTRAL] OK, and what's the total charge amount?
[CUSTOMER][NEUTRAL] $360.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] Verification of coverage does not guarantee the payment of a claim. Let me take a look and see if I can look at that.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] One moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, and let's see here. So I was able to locate that claim.
[AGENT][NEUTRAL] That claim number is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 353.
[AGENT][NEUTRAL] 349-6. It was received on [PII]. It was processed on [PII]. The claim made a payment of $126 even.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright. Give me 1 2nd to take a look at one other thing.
[AGENT][NEUTRAL] And that was paid according to the uh explanation of benefits that was submitted. The patient's responsibility was 126 and that's what we reimbursed. All right. And what's your next date of service?
[CUSTOMER][NEUTRAL] Next date of service is [PII].
[AGENT][NEUTRAL] OK, what's the charge amount?
[CUSTOMER][NEUTRAL] Um, $180.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][POSITIVE] Thank you for your patience. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, that claim number is 353.
[AGENT][NEUTRAL] 349 5.
[AGENT][NEUTRAL] And that claim was received on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII] and it was paid on [PII] and it paid $63 which is what the patient's responsibility was according to the OB.
[AGENT][NEUTRAL] What's your next data service?
[CUSTOMER][NEUTRAL] Um, next date of service is [PII], and, um, am I able to get like check numbers um on the portal or do you have that information for me?
[AGENT][NEUTRAL] What do you mean text numbers? I'm not sure what you're saying. Are you needing a duplicate copy of the primary of of of our EOB? Is that what you're wanting?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I don't, I don't know what you mean when you say texted numbers, but you can request a duplicate copy of the EOB.
[CUSTOMER][NEUTRAL] Che
[AGENT][NEUTRAL] And I can have that faxed to you and what is your fax number?
[CUSTOMER][NEUTRAL] Fax number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] detention of whom?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. All right. Now, let me look up [PII] for you. One moment.
[CUSTOMER][POSITIVE] OK, thank you very much.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Really
[AGENT][NEUTRAL] Alright, that claim number is 353.
[AGENT][NEUTRAL] Uh, wait a minute, 3552.
[AGENT][NEUTRAL] 753-535-275 it was received on November.
[AGENT][NEUTRAL] [PII] and it was paid on [PII] and let's see what the amount was. The amount that was paid was $63.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Alright, is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] That is all, uh, actually I'm sorry, I have one more, um, it's [PII]. I apologize.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what's what's the name?
[AGENT][NEUTRAL] That's OK. [PII]. What's the charge amount?
[CUSTOMER][NEUTRAL] $180.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Thank you for your patience again one moment.
[AGENT][NEUTRAL] All right, that claim was received on [PII]. It was paid on [PII]. The claim number is 353.
[AGENT][NEUTRAL] 5282.
[AGENT][NEUTRAL] The amount of the payment was $63.
[CUSTOMER][POSITIVE] OK, thank you very much.
[AGENT][POSITIVE] Alright, you're welcome. Thank you for calling APL Avery have a great day and stay safe bye bye.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] Thank