AccountId: 011433970860
ContactId: 74c377a4-c3fa-4e45-acdc-f11af17c872e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 872950 ms
Total Talk Time (AGENT): 223669 ms
Total Talk Time (CUSTOMER): 264391 ms
Interruptions: 12
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/74c377a4-c3fa-4e45-acdc-f11af17c872e_20250121T14:03_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] This is. How can I help you? Hi, this is [PII] calling from provider's office to check the claim status.
[AGENT][NEUTRAL] OK [PII], you're needing claim status, is that correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Yes, I can help you with that and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Yes, I can help you with that, what is your callback number? [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And how many claims [PII] do you have to check status on?
[CUSTOMER][NEUTRAL] Thank you. And how many points do I have to check out for?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] One moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have 2 claims. Can I check with that.
[AGENT][NEUTRAL] OK, are the two claims for the same member and different dates of service or two different members?
[CUSTOMER][NEUTRAL] D2 different numbers.
[AGENT][NEUTRAL] Yes, I can help you and [PII] will use my name that I gave you along with today's date as your call reference number for each one. Also, any information that I provide will be a verification of benefits and not a guarantee of payment on the claims. And lastly, should you need a copy of either explanation of benefits, if we have the claims on file, you can print those EOBs from our portal by going to secured.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] As your reference number for each.
[CUSTOMER][NEUTRAL] Also the information that I am for your verification of benefits and not a guarantee of payment on the claim.
[CUSTOMER][NEUTRAL] When should you need a copy
[CUSTOMER][POSITIVE] benefits
[CUSTOMER][NEUTRAL] Well you can.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is your first patient's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] 15371.
[AGENT][NEUTRAL] OK, that's not a policy number.
[CUSTOMER][NEUTRAL] OK, that's not a policy number.
[CUSTOMER][NEUTRAL] That is on here. One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One moment, sorry, sorry.
[AGENT][NEUTRAL] Oh, you're fine. Mhm. OK.
[CUSTOMER][NEGATIVE] System is slow.
[AGENT][NEUTRAL] What is your patient's name, [PII], and date of birth? I mean, well, no, not date of birth yet. What is the last name and first name?
[CUSTOMER][NEUTRAL] Vision for first.
[CUSTOMER][NEUTRAL] [PII] as in Alpha, [PII] as in Lima. [PII] as in Yankee, S as [PII] as [PII] Alpha, and the last name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, just one moment.
[CUSTOMER][NEUTRAL] Can I say the policy number?
[AGENT][NEUTRAL] Uh, I need for you to give me the policy number. I'm trying to locate the member without it.
[CUSTOMER][NEUTRAL] Uh I
[CUSTOMER][NEUTRAL] And the number I'm trying to get the number.
[AGENT][NEUTRAL] Spell the last name again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I'm so sorry, [PII]. Say, I'm sorry, spell the last name one more time.
[CUSTOMER][POSITIVE] I'm so sorry that I'm sorry.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, just a moment. I'm not seeing a member with that last name. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you say the claim number or policy number?
[CUSTOMER][NEUTRAL] Can you check with that?
[AGENT][NEUTRAL] You already have a claim number?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yes, can I get the claim number?
[AGENT][NEUTRAL] [PII], I'm sorry. I'm not understanding what you said. What, what was the last thing you said?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Can I say the claim number?
[AGENT][NEUTRAL] [PII], I can't locate this person by this name.
[CUSTOMER][NEUTRAL] Can I say the claim number?
[CUSTOMER][NEUTRAL] Can you say the claim number? Can you?
[AGENT][NEUTRAL] Do you have the claim number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Do you have the claim number? What is the claim number?
[CUSTOMER][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] 35
[CUSTOMER][NEUTRAL] 24
[CUSTOMER][NEUTRAL] 342
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] What is the patient's date of birth?
[CUSTOMER][NEUTRAL] What is the patience date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] What is the data service and total bill amount?
[CUSTOMER][NEUTRAL] What is the data service
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Native service
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 2024.
[CUSTOMER][NEUTRAL] And the bill amount is $18,928 even.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK [PII], and how can I help you with this claim today?
[CUSTOMER][NEUTRAL] Claim status.
[AGENT][NEGATIVE] This claim was denied.
[AGENT][NEUTRAL] And the reason for the denial is because we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] the primary insurance that needed primary.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We have primary OB. Can you tell me the fax number?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Um sorry, can you repeat again? Sorry for that. Sorry for that. Can you repeat again?
[AGENT][NEUTRAL] 1877.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] 87
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] 5423.
[CUSTOMER][NEUTRAL] OK, may I know the claim disputed and denied it.
[AGENT][NEUTRAL] One moment.
[AGENT][NEGATIVE] Received [PII]28 processed and denied on [PII].
[CUSTOMER][NEUTRAL] OK, call reference number for this?
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] Department
[CUSTOMER][NEUTRAL] Call reference number for this.
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][NEUTRAL] What is your name?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And is there anything else, [PII] I can help you with?
[CUSTOMER][NEUTRAL] Can I check with the next
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And the next policy number?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 51
[CUSTOMER][NEUTRAL] 4350.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And any information that I provide on this one will be the same, verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] We have a verification and benefits uh guarantee.
[CUSTOMER][NEUTRAL] What was your patient
[CUSTOMER][NEUTRAL] Put your name
[CUSTOMER][NEUTRAL] [PII] and the last name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Day of service and total bill amount.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Uh, yes, [PII] 24.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the bill amount is $6,944.65.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] So I do see that this claim was also received. One moment.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] The claim was received on [PII], processed and denied on [PII].
[CUSTOMER][NEUTRAL] When we receive the same process and time on [PII].
[AGENT][NEUTRAL] Claim number is 3542358.
[AGENT][NEGATIVE] And this was denied for this.
[CUSTOMER][NEUTRAL] Sorry, can you repeat again? 546 claim number.
[AGENT][NEUTRAL] 3542358
[CUSTOMER][NEUTRAL] 354.
[CUSTOMER][NEUTRAL] 2378.
[CUSTOMER][NEUTRAL] Did I?
[AGENT][NEUTRAL] Uh, we also need the primary insurance company's explanation of benefits on this one as well.
[CUSTOMER][NEUTRAL] Not
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] We have A will be
[CUSTOMER][NEUTRAL] Can you tell me the fax numbers for that.
[AGENT][NEUTRAL] Yes, sir, would be the same fax number I gave you a moment ago.
[CUSTOMER][NEUTRAL] Same fax number.
[AGENT][POSITIVE] Mhm. That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you tell me the call reference number for this?
[AGENT][NEUTRAL] My name in today's date?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you for that.
[AGENT][POSITIVE] You're very welcome. And was that the last one that you had?
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] No, the, uh, completed to only.
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][POSITIVE] There is no other claim. Thank you. Thank you for the information.
[AGENT][POSITIVE] OK. Well, you're very welcome. And so if that is all I can help you with, [PII], thank you again for calling APL and I hope that you have a very nice day.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Same to you.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye-bye.