AccountId: 011433970860
ContactId: 77905327-e8bc-497b-b776-7f2ce03cad19
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 409200 ms
Total Talk Time (AGENT): 159416 ms
Total Talk Time (CUSTOMER): 96135 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/77905327-e8bc-497b-b776-7f2ce03cad19_20250129T18:43_UTC.wav
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[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII].
[CUSTOMER][NEUTRAL] And I'm calling for claim status.
[AGENT][NEUTRAL] OK, yeah, I can check on a claim for you. [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] Alright, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number it is.
[CUSTOMER][NEUTRAL] 2, I'm sorry, 02444067.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] Uh, what was the name and date of birth for the member?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, thank you for verifying that [PII]. And what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII], um, [PII].
[AGENT][NEUTRAL] OK, do you have that bill amount?
[CUSTOMER][NEUTRAL] $460.10.
[AGENT][NEUTRAL] And 10 cents.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Got it. OK, thank you. One moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry [PII], what was the name of the uh provider's office?
[CUSTOMER][NEUTRAL] Piedmont Urgent Care by Well Street.
[AGENT][POSITIVE] OK, thank you. I do believe I've found it. Give me just a moment.
[AGENT][NEUTRAL] OK, it looks like there are several duplicates. Bear with me for just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Bear with me. I think we received this claim. It looks like uh at least 6 times. Give me just a moment. I'm finding all the duplicates. Hold on just a moment.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] There we are, OK, so I did find the original claim, awesome, so it looks like we paid a benefit of $75 for this claim that did meet their maximum benefit payable for the date of service.
[CUSTOMER][NEUTRAL] OK, you see the claim pay $75?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Does the patient has responsibility?
[AGENT][NEUTRAL] We do not say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK, um, can we receive a copy of the EOB?
[AGENT][NEUTRAL] Of course, uh, do you have a fax number?
[CUSTOMER][NEUTRAL] Yes, it is. You ready?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it is the same as the callback number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, OK, and when I just put this to your attention [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][NEUTRAL] Got it. OK, alrighty I will get that sent to you um was there anything else I could help you with? Did you need that claim number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, the claim number is 3460079.
[CUSTOMER][NEUTRAL] I have 3460079. Can I have a received date and a process date?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Oh yes, give me just a moment.
[AGENT][NEUTRAL] OK, uh, so this claim was received [PII], and it was processed [PII].
[CUSTOMER][NEUTRAL] OK. So the EOB gonna let me know that I I see the um like the flu the, the vaccine was not covered, just the office visit.
[AGENT][POSITIVE] Correct, yes, it will give uh all of the reasons for each of the uh procedure codes.
[CUSTOMER][NEUTRAL] OK, I have one more question. Can you verify the billing the billing address that you guys have on file?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Um, that we sent the check to you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, give me just a moment, let me get that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the address we sent it to was [PII].
[CUSTOMER][NEUTRAL] OK, that's correct. Can I have a check number?
[AGENT][NEUTRAL] OK, yes, it is 18.
[AGENT][NEUTRAL] 53
[AGENT][NEUTRAL] 858.
[CUSTOMER][NEUTRAL] And so the, the check date is the same as the process date?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] That was when the check was issued was [PII]. Um, I am showing that the check did clear [PII].
[CUSTOMER][NEUTRAL] [PII] it's a clear date.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] OK. And should I receive that copy of the EOB? Would it be today?
[AGENT][NEUTRAL] Oh yeah, I just sent it, um, so you should get it, um, maybe 10-15 minutes depending on how busy your machine is.
[CUSTOMER][NEUTRAL] Oh, I think I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thank you, unless I need, I need a car re do you have a card reference number?
[AGENT][NEUTRAL] Of course, yes, uh, that would be my first name, last initial, and today's date. Uh, so my name is spelled [PII] Was there anything else I could help you with [PII]?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] No, that'll be it. Thank you so much.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You do the same. OK, bye.
[AGENT][POSITIVE] Thank you bye