AccountId: 011433970860
ContactId: 738f4f65-d278-436a-b588-eb03d3b38d2f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 694479 ms
Total Talk Time (AGENT): 226919 ms
Total Talk Time (CUSTOMER): 230575 ms
Interruptions: 5
Overall Sentiment: AGENT=0.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/738f4f65-d278-436a-b588-eb03d3b38d2f_20250131T18:19_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, my name is [PII] calling from provider's office, checking on claim status and how are you doing today?
[AGENT][POSITIVE] I'm doing well [PII] how are you?
[CUSTOMER][POSITIVE] Being pretty well, thank you for asking. Could you please spell your name?
[AGENT][NEUTRAL] Sure, it's [PII].
[CUSTOMER][POSITIVE] Thank you for that.
[AGENT][POSITIVE] Of course, yeah, I could definitely check on a claim for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] 00971138.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Your patient's name, [PII].
[CUSTOMER][NEUTRAL] The date of birth, [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII] uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII] for $358 even.
[AGENT][NEUTRAL] I'm sorry, that was $358?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you one moment please.
[AGENT][NEUTRAL] OK, so I did find this claim, [PII], uh, we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Give me a moment. I'm on your portal. I'm just logging on your portal that I'm able to find the claim or not. Just one moment, sorry for the delay. Yes, I do have this one.
[AGENT][NEUTRAL] Sure I can give you that claim number if you need it.
[CUSTOMER][NEUTRAL] Yes, one moment. Just logging on the claim. One moment. Sorry for that. Just help me out with the claim number? Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes, the claim number is 34.
[AGENT][NEUTRAL] 87
[AGENT][NEUTRAL] 978.
[CUSTOMER][NEUTRAL] The patient's first name is [PII] and date of birth [PII].
[CUSTOMER][NEUTRAL] Help me out with the date of birth?
[AGENT][NEUTRAL] Um, let's see, give me just a moment. That was [PII]. It, it was [PII], yeah.
[CUSTOMER][NEUTRAL] [PII]. 1 moment. OK, I got it. [PII].
[CUSTOMER][POSITIVE] Just one moment. Thank you.
[CUSTOMER][NEUTRAL] Yes, I was able to find the claim. Thank you. Help me out, when did you receive the claim? Just for documentation purpose. I'm just downloading the claim. Uh-huh.
[AGENT][NEUTRAL] OK, of course.
[AGENT][NEUTRAL] Sure, yeah, the claim is received, uh, [PII].
[AGENT][NEUTRAL] And it was processed.
[CUSTOMER][NEUTRAL] July
[CUSTOMER][NEUTRAL] Uh-huh. [PII] process, uh-huh.
[AGENT][NEUTRAL] Yes, processed let's see.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Uh-huh, yes, thank you.
[CUSTOMER][NEUTRAL] Help me what the plan does the patient have, like supplement gap plan like that?
[AGENT][NEUTRAL] It is supplemental. It is a secondary medical plan.
[CUSTOMER][NEUTRAL] Supplemental Medicare, uh, medical supplemental plan. Secondary plan, sorry. OK.
[AGENT][NEUTRAL] Uh, secondary medical, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Almost done. Thank you.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Call reference number would be your name, right?
[AGENT][NEUTRAL] Uh, it would be my first name, last initial, and today's date. Uh, so my name is spelled [PII] Was there anything else I can help you with, [PII]?
[CUSTOMER][NEUTRAL] Last initial?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I do have 2 more claims, please, [PII].
[AGENT][NEUTRAL] Is this going to be for the same member or for a different member?
[CUSTOMER][NEUTRAL] Different number.
[AGENT][NEUTRAL] OK, give me just a moment with a different policy, is that right?
[CUSTOMER][POSITIVE] Yes, different patient and different policy. You are right.
[AGENT][NEUTRAL] OK, OK, yes, give me just a moment I'll let you know when I'm ready.
[CUSTOMER][POSITIVE] Yeah. Just finish up your documentation. Thank you.
[AGENT][POSITIVE] Who appreciate it
[AGENT][NEUTRAL] OK, I'm ready for that next policy number when you are.
[CUSTOMER][NEUTRAL] Uh, just one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, ID number starting from?
[CUSTOMER][NEUTRAL] 021387557.
[AGENT][NEUTRAL] OK, thank you and what was the name and date of birth for this number?
[CUSTOMER][NEUTRAL] Under [PII]. Date of birth [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you and then what was the date of service please?
[CUSTOMER][NEUTRAL] No, [PII] for $542 even.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so, uh, this one is the same as the other [PII] uh office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Claim number, please.
[AGENT][NEUTRAL] Yes, that is 348-6204.
[CUSTOMER][NEUTRAL] OK, thank you. I found the EOB. Help me out when was the claim denied on?
[AGENT][NEUTRAL] Uh, this claim was processed [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Denied.
[AGENT][NEGATIVE] Um, OK, so we received the claim [PII]. It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] Be
[CUSTOMER][POSITIVE] [PII]. Thank you.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Almost done. One moment, sorry for the delay. So I'm just thank you.
[AGENT][NEUTRAL] Sure you're fine, yeah.
[CUSTOMER][NEUTRAL] Same like previous one, the patient has same plan as a supplemental gap plan?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] That's correct this is the same kind of plan.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Ready for the last ID number?
[AGENT][NEUTRAL] Uh yes, give me just a moment.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] yeah.
[AGENT][POSITIVE] OK, yes, I'm ready.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yes, last ID number starting from 0, 60801.
[AGENT][NEUTRAL] Uh, so that's actually our payer ID, [PII], um, that's not going to be a policy number.
[CUSTOMER][NEUTRAL] 60.
[CUSTOMER][NEUTRAL] 60801 going to be your pay tax payer ID. Sorry for that. Can I provide you the patience?
[AGENT][NEUTRAL] That's our payer ID, yes.
[CUSTOMER][NEUTRAL] I'll provide you the patient's first and last name. The patient's first name is [PII].
[AGENT][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] Do you happen to have their um do you have their social by chance?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh, one moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Patient does not have social, uh-huh, sorry.
[AGENT][NEUTRAL] OK, that's fine no that's OK um yeah if you wouldn't mind just spelling out the first and last name for me.
[CUSTOMER][NEUTRAL] First name spelled [PII].
[CUSTOMER][NEUTRAL] And the last name spelled [PII]?
[AGENT][NEUTRAL] OK, that was [PII].
[CUSTOMER][NEUTRAL] [PII], no, no. [PII].
[AGENT][POSITIVE] Got it OK thank you one moment.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, um, and then did you have the date of birth for this number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. OK, um, did you want that correct policy number, [PII]?
[CUSTOMER][POSITIVE] Go ahead. That would be helpful for the future.
[AGENT][NEUTRAL] Absolutely, OK, uh, that is 02.
[AGENT][NEUTRAL] 35
[AGENT][NEUTRAL] 3179.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Of course and then what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] OK and the bill amount please?
[CUSTOMER][NEUTRAL] $348 even?
[AGENT][NEUTRAL] 348. OK, thank you one moment.
[AGENT][NEUTRAL] Alrighty, uh, this one is the same as the others as well, [PII], um, office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Uh, one moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Claim number?
[AGENT][NEUTRAL] It is 3453.
[AGENT][NEUTRAL] 387.
[CUSTOMER][NEUTRAL] Uh, help me out with the patient's date of birth, please. I'm on your portal.
[AGENT][NEUTRAL] Oh yes, give me just a moment, let me go grab that. That is 64-1991.
[CUSTOMER][NEUTRAL] Thank you. And I found the copy of your bill. And when did you denied the claim?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh, so the claim was received [PII], and it was processed [PII].
[CUSTOMER][POSITIVE] Claim number as you provided. Thank you. Thank you for your assistance. Have a great day. Same plan, right? supplemental plan.
[AGENT][NEUTRAL] Yes sir.
[AGENT][POSITIVE] Yeah, was there anything else I can help you with? Yes, yes, it's the same kind of plan. Alright, well thanks for giving us a call, [PII]. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] That's it.
[CUSTOMER][NEUTRAL] Wish you the same bye bye.
[AGENT][NEUTRAL] Bye bye.