AccountId: 011433970860
ContactId: 6f890f9c-5e63-4bcd-8557-e63498d2f977
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 340390 ms
Total Talk Time (AGENT): 127689 ms
Total Talk Time (CUSTOMER): 122192 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/6f890f9c-5e63-4bcd-8557-e63498d2f977_20250213T20:57_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] You said [PII]?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, hi, my name is [PII]. I'm calling from Prima Health, so I don't know if I'm speaking with the right department or not.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What information can I give you though?
[AGENT][NEUTRAL] Uh, what's the policy number you're inquiring about?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] It's D.
[CUSTOMER][NEUTRAL] I make sure I'm getting you right that's D43723821.
[AGENT][NEUTRAL] OK, it's not one of our policy numbers. Uh, do you have the patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Spell that last name for me.
[CUSTOMER][NEUTRAL] Um, date of birth June.
[AGENT][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] [PII], no, it's fine. [PII]
[AGENT][NEUTRAL] Z or G? I'm sorry.
[CUSTOMER][NEUTRAL] G finger like.
[AGENT][NEUTRAL] Oh, finger. That's why I left. OK. And the date of birth, I'm sorry.
[CUSTOMER][NEUTRAL] Point your finger, like.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, thank you. And you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes, it is.
[AGENT][NEUTRAL] OK, let me see if I can find them in our system.
[AGENT][POSITIVE] Good.
[CUSTOMER][NEUTRAL] Um, on the EOB that I'm looking at, it says this is not an ACA preventative service but may be reimbursable under an APL product and you guys are APL that's why I pressed the option. I didn't hear an option for ACA.
[AGENT][NEUTRAL] Oh, OK. And what was the data service for?
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, cause I show he had a medical policy with us and
[AGENT][NEUTRAL] Um, let me see if we received any claims or if he was eligible. Give me one moment.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what was the total charge amount?
[CUSTOMER][NEUTRAL] Um, it was $7,327.60.
[AGENT][NEUTRAL] Let's see, because he was eligible.
[AGENT][NEUTRAL] Let me just.
[AGENT][NEUTRAL] And you're calling from again?
[CUSTOMER][NEUTRAL] Prisma Health Baptist Easily Hospital.
[AGENT][NEUTRAL] OK. It looks like we received the claim but it processed as.
[AGENT][NEUTRAL] See
[AGENT][NEUTRAL] Oh, it looks like we received that claim and it processes the max, uh benefit max for the day the service had been met.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I didn't see that on the EOB so.
[AGENT][NEUTRAL] Well, it's probably does the one ELB you have, does it show IMA or does it show APL?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, where would that be like up top?
[AGENT][NEUTRAL] I think so. I don't know what their EOBs look like, but he had a policy, a medical policy, if claims are submitted through a certain pay ID number, address, it goes to IMA and to APL, and it looks like we received the claim, but it just processes benefits max. But you should have received their uh our EOB. Would you like me to fax it to you?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, if you can, cause I mean.
[CUSTOMER][NEUTRAL] No, no payment. I was about to say small payment now, there's not even a small payment, um, yeah, um, because.
[CUSTOMER][NEUTRAL] I guess the the EOB I have must be the other.
[CUSTOMER][NEUTRAL] ACA, whatever that means.
[CUSTOMER][NEUTRAL] I mean it just says 90 degree benefits. It doesn't distinguish which side it is or.
[AGENT][NEUTRAL] 0, 90 degree, yeah, that's, uh, IMA, but, um, Ms. [PII], what is your fax number?
[CUSTOMER][NEUTRAL] Um, it's 864.
[CUSTOMER][NEUTRAL] 522
[CUSTOMER][NEUTRAL] 958 7
[AGENT][NEUTRAL] OK, that's [PII].
[CUSTOMER][NEUTRAL] And if you could put it to
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah, to my attention, [PII] or [PII] gives doesn't matter. [PII]
[AGENT][NEUTRAL] Do you have the [PII] or [PII]?
[CUSTOMER][NEUTRAL] Uh [PII]
[AGENT][NEUTRAL] [PII]. OK, I will send this off to you in a few moments.
[CUSTOMER][POSITIVE] OK, sounds great.
[CUSTOMER][NEUTRAL] Um, is there a call reference number?
[AGENT][NEUTRAL] No, ma'am. Uh, if you like, you may use my name at today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] Uh, yes, ma'am. Thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Bye bye.