AccountId: 011433970860
ContactId: 7436e04b-5742-40f8-b2d5-6e3a99d6b72d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 328779 ms
Total Talk Time (AGENT): 147623 ms
Total Talk Time (CUSTOMER): 120780 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/7436e04b-5742-40f8-b2d5-6e3a99d6b72d_20250210T17:57_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling from a medical provider's office, and I'm looking to see if you could fax over a copy of an explanation of benefits, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Can I have that callback number for you, [PII] and that policy number?
[CUSTOMER][NEUTRAL] Sure, my callback number is [PII].
[CUSTOMER][NEUTRAL] And his ID number I have is 024.
[CUSTOMER][NEUTRAL] 86627.
[CUSTOMER][NEUTRAL] [PII] [PII], [PII].
[AGENT][NEUTRAL] Thank you. And what is that member's name and date of birth?
[CUSTOMER][NEUTRAL] This is for [PII] [PII].
[AGENT][NEUTRAL] And what is the date of service that you're requesting the ELB for?
[CUSTOMER][NEUTRAL] This is back on [PII]. I understand the payment went to the patient, but I need to be able to have something to post to send the charges to him.
[AGENT][NEUTRAL] [PII]. What is your procedure code?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It was 99213.
[AGENT][NEUTRAL] Mm, no payment went to the.
[CUSTOMER][NEUTRAL] For $295.
[AGENT][NEUTRAL] There was no payment went to the insured. This was the services that's not covered under the, no, we're requesting the EOB to be sent in for [PII] for [PII]. We requested a primary EOB.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK. Um, so I'm assuming you didn't get the fax then. Um, I have a fax.
[AGENT][NEUTRAL] 0262.
[AGENT][NEUTRAL] When did you send the fax in?
[CUSTOMER][NEUTRAL] It was sent on [PII].
[AGENT][NEUTRAL] Hold one moment.
[CUSTOMER][NEUTRAL] And the fax number is [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Fax number is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you say you sent it in when, bunny?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEGATIVE] No, we didn't receive anything for [PII].
[CUSTOMER][NEUTRAL] You didn't.
[AGENT][NEUTRAL] What was the date of service? Give it to me one more time.
[CUSTOMER][NEUTRAL] Um, yeah, [PII].
[AGENT][NEUTRAL] [PII]. Make sure we're under the right policy because it looks like we're not under the right policy.
[CUSTOMER][NEUTRAL] Oh, he's got more than one.
[AGENT][NEUTRAL] Uh, yes, because the policy that I currently was under that you provided me with was active from [PII] and currently active.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] So we built the wrong policy.
[AGENT][NEUTRAL] So we can only send you a copy of the EOB that was sent to you for the duplicate. We can't send you the copy of the one that we paid the actual insurer, but let me give you the correct policy number. 325.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And when was this one effective?
[AGENT][NEUTRAL] This policy was active from [PII] [PII].
[CUSTOMER][NEUTRAL] 5120.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the policy number is 2196791. That's 219-6791. What is your fax number?
[CUSTOMER][NEUTRAL] Um, my fax is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, [PII], is there anything else that you would like for me to assist you with today?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Um, no, I guess I could, can I confirm with you that you did send the payment to the patient?
[AGENT][NEUTRAL] Yeah, the payment was made to the insured, but I can't discuss it with you. I can only give you information in regards to your ELB which just states that the payment went to to the insured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's as long as I can send him something.
[AGENT][NEUTRAL] For the claim number, let me give you the claim number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 354.
[AGENT][NEUTRAL] 3254. That is your claim number for the claim that you guys sent in and we said it was a due to the.
[AGENT][NEUTRAL] Insurers submit a claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So this isn't the denial for a duplicate.
[AGENT][NEGATIVE] It's a denial for we pay the insured.
[CUSTOMER][POSITIVE] OK, got you. That's what I'm looking for. Awesome. And I do apologize greatly. What was your name again?
[AGENT][NEUTRAL] My name is [PII], and today's date is a reference but you did say that your fax number was [PII].
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] No, that's all I have. Thank you so much for your help, [PII].
[AGENT][POSITIVE] You're welcome. Thanks for calling APL Bunny. Have a great day.
[CUSTOMER][POSITIVE] Thanks you too. Bye.
[AGENT][POSITIVE] Thanks. Goodbye.