AccountId: 011433970860
ContactId: 772e987f-d1a9-4c15-b23a-5cca11f4287b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 339079 ms
Total Talk Time (AGENT): 106781 ms
Total Talk Time (CUSTOMER): 178420 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/772e987f-d1a9-4c15-b23a-5cca11f4287b_20250318T15:40_UTC.wav
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[AGENT][NEUTRAL] For calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] sent through the mail.
[CUSTOMER][NEUTRAL] Um, yes, I'm calling in regards to a patient, um, to see if they're active for coverage.
[AGENT][POSITIVE] I'd be happy to assist with the eligibility. May I have your first name please?
[CUSTOMER][NEUTRAL] Yes, it's [PII] calling from Treasure Coast Community Health.
[AGENT][POSITIVE] And Socia if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] It is 02511267.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII]. And are you needing a fax back breakdown of the benefits?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, yes, because I, I, I sent out the claim, but, um, it didn't, for some reason it didn't go out for a certain certain data services, and I just wanna make sure I have the correct claims address on file.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Um,
[AGENT][NEUTRAL] That claim's mailing address, um, did you, is it the [PII]? Yeah, that's the correct one.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Uh huh
[CUSTOMER][NEUTRAL] Yes, correct one OK and are you able to look into a few claims, um, because I have.
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] Um, hold on for [PII]?
[AGENT][NEUTRAL] I'm showing the payment was made in the amount of.
[AGENT][NEUTRAL] $132.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, what's the.
[AGENT][NEUTRAL] And that was made on [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And how do you guys send out the payments? Is it check or EFT or direct deposit check?
[AGENT][NEUTRAL] Check.
[CUSTOMER][NEUTRAL] And can you um let me know what address you sent it to? Is it the same claims address for the provider? The [PII], OK.
[AGENT][NEUTRAL] Uh, let me check on the check.
[AGENT][NEUTRAL] It went to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Can you
[CUSTOMER][POSITIVE] Catch a good.
[AGENT][NEUTRAL] Uh-huh. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 121 94ler OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And do you know if it was cleared on your end?
[AGENT][POSITIVE] No, it's still um outstanding.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So in order if this was not received and we can't find a check, is there a way for you to reissue another check?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Or OK, and what is the what do I need to do with that? Do I just um call you guys back and.
[AGENT][NEUTRAL] Yeah, just call us back and let us know you can't find it and then we'll do the stop pay and reissue.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and then can you look at 2 more data services for me?
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] Um, the [PII].
[AGENT][NEGATIVE] OK, so the 1330 code denied because that's not covered, it's not listed on the schedule.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the other two.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Denied because of the waiting period, hadn't been met. It's a 12 month waiting period.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, waiting period 12 months, OK.
[CUSTOMER][NEUTRAL] So my waiting period, OK, and then data service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's just the same thing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, the [PII].
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Not on the schedule and the other one did not for waiting period.
[CUSTOMER][NEUTRAL] My parent, OK.
[CUSTOMER][NEUTRAL] And then let me make sure.
[CUSTOMER][NEUTRAL] OK, I got that one.
[CUSTOMER][POSITIVE] [PII] they paid OK OK yeah I think that's um all the visits right thank you so much.
[AGENT][NEUTRAL] Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] No ma'am that's it thanks.
[AGENT][POSITIVE] Thank you for calling APL. You have a good day.
[CUSTOMER][NEUTRAL] Oh, and one more question, sorry.
[CUSTOMER][NEUTRAL] For that, um, data service for 12-11-2024 that paid the 132, are you able to give me the check number so we can verify and see if we did receive it in our office?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] That check number is 2021805.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] Thank you for calling APL you have a good day.
[CUSTOMER][NEUTRAL] Alright, OK, you too bye bye.
[AGENT][NEUTRAL] Bye