AccountId: 011433970860
ContactId: 78d108f9-8e3e-4af6-969f-8d30c0417164
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1256609 ms
Total Talk Time (AGENT): 177016 ms
Total Talk Time (CUSTOMER): 360735 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/78d108f9-8e3e-4af6-969f-8d30c0417164_20250421T14:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from the provider's office to check on a claim status. Can you please help me?
[AGENT][NEUTRAL] Yes, I can help you with claim status, [PII]. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, my callback number is [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It is 025552777.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Will you give me that policy number one more time? So sorry.
[CUSTOMER][NEUTRAL] Sure. It is 025552777.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what was that date of service? Filled them out?
[CUSTOMER][NEUTRAL] Data service is [PII]. Bill amount is $1,593 even.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] 1000. What was the bill amount? I'm sorry.
[CUSTOMER][NEUTRAL] 1593.
[AGENT][POSITIVE] OK, thank you. Let's see.
[CUSTOMER][NEUTRAL] And how many claims you can help me with on a call?
[AGENT][NEUTRAL] How, how many do you have?
[CUSTOMER][NEUTRAL] Um, actually, I do have 11 claims with me.
[AGENT][NEUTRAL] OK, do you have access to our portal?
[CUSTOMER][NEUTRAL] Um, no.
[AGENT][NEUTRAL] I is that something you're able to get set up?
[AGENT][NEUTRAL] Cause you can pull EOBs from there immediately, access claim status.
[CUSTOMER][NEUTRAL] about
[CUSTOMER][NEUTRAL] OK, so isn't it possible if you can help me with the call?
[CUSTOMER][NEUTRAL] Lord
[AGENT][NEUTRAL] Uh, this claim was received 11-22-2024, processed 11-26-2024.
[AGENT][POSITIVE] And the benefit maximum has been met for the day.
[AGENT][NEUTRAL] For the, for the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh. Got that. And can you please also provide me whether the
[CUSTOMER][NEUTRAL] Benefits were in terms of visits or dollars?
[AGENT][NEUTRAL] That's dollars.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] It's dollars.
[CUSTOMER][NEUTRAL] Uh-huh. OK.
[CUSTOMER][NEUTRAL] OK, got it. And whether it was terminated on, I mean, the benefits were exhausted on the date of service or before the date of service?
[AGENT][NEUTRAL] Um, I'm sorry, what was the question?
[CUSTOMER][NEUTRAL] No, the benefits were exhausted um on the date of service or before the date of service.
[AGENT][NEGATIVE] Um, it was exhausted on the day of service.
[CUSTOMER][NEUTRAL] OK. And uh can you please also confirm the complete amount of patients responsibility or is there any provider's discount?
[AGENT][NEUTRAL] Uh, we don't determine patient responsibility. It's a supplemental policy.
[CUSTOMER][NEUTRAL] Oh, OK. I got that.
[CUSTOMER][NEUTRAL] And can you please also confirm the claim number is 353-4790?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Mhm. Got that. Thank you. And may I have the call reference number and we can move to the next patient?
[AGENT][NEUTRAL] It's my name, [PII]. Today's date.
[CUSTOMER][NEUTRAL] Mhm. I got that.
[CUSTOMER][POSITIVE] And I am ready with the next patient.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, policy number.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The policy number, it is
[CUSTOMER][NEUTRAL] D as in Delta 404-083-02.
[AGENT][NEUTRAL] Um, that's not our policy number. Do you have the last name?
[CUSTOMER][NEUTRAL] Yes, the last name is.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The first name?
[CUSTOMER][NEUTRAL] First name is [PII]
[AGENT][NEUTRAL] Do you have a claim number for this?
[CUSTOMER][NEUTRAL] For this one, just a moment.
[CUSTOMER][NEUTRAL] No, ma'am. I don't have a claim number for this patient.
[AGENT][NEUTRAL] Day of service build out.
[CUSTOMER][NEUTRAL] Date of service is [PII]. The amount is $1,593 even.
[AGENT][NEUTRAL] And the benefit maximum has been met for the policy, dollar amount, received 5-15-2024.
[AGENT][NEUTRAL] Process [PII] 2024.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And may I also have the claim?
[CUSTOMER][NEUTRAL] Claim number
[AGENT][NEUTRAL] 345
[AGENT][NEUTRAL] 6390.
[CUSTOMER][NEUTRAL] OK. Got it.
[CUSTOMER][NEUTRAL] OK just a moment.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] And for this one, could you please also send me the copy of your be to my fax number?
[AGENT][NEUTRAL] What's your facts?
[CUSTOMER][NEUTRAL] It is 337289.
[CUSTOMER][NEUTRAL] 376 9.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And how much time it would take for the year to be received?
[AGENT][NEUTRAL] Oh, it takes about 5 minutes after we get off the call.
[AGENT][NEUTRAL] What's the next policy?
[CUSTOMER][POSITIVE] Oh, OK. Got that. Thank you.
[CUSTOMER][NEUTRAL] Next policy ID it is D as in Delta 4768.
[AGENT][NEUTRAL] Um, the D's don't.
[AGENT][NEUTRAL] The the policies, that's not one of our numbers, so what's the last name?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is [PII]
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] Member's name, first name is [PII], that is [PII]
[AGENT][NEUTRAL] Last name is [PII]
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] I'm not pulling that up in our system.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is there any other um source where we can find the patient?
[AGENT][NEUTRAL] What's the group number?
[CUSTOMER][NEUTRAL] Mm, sure. Group number I see is 9476.
[AGENT][NEUTRAL] I'm not pulling anything up under that.
[CUSTOMER][NEUTRAL] OK, so we can move to the next patient.
[AGENT][NEUTRAL] OK, the number?
[CUSTOMER][NEUTRAL] The ID is 02017301.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Data service and build them out.
[CUSTOMER][NEUTRAL] Date of service is [PII]. The amount is $1,487 even.
[AGENT][NEUTRAL] Uh, that was received 11-25-2024. Proceed [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Uh, Benefit Dollar Max has been met for this service.
[CUSTOMER][NEUTRAL] OK just a moment.
[CUSTOMER][NEUTRAL] OK, got that.
[CUSTOMER][NEUTRAL] OK, I'm almost done here just a moment.
[CUSTOMER][NEUTRAL] And can we move to the next patient?
[AGENT][NEUTRAL] OK. The policy number?
[CUSTOMER][NEUTRAL] It is A as in Alpha, 634.
[CUSTOMER][NEUTRAL] 02110
[AGENT][NEUTRAL] Uh, we don't have numeric, uh, we don't have numeric. There's no, uh, or there's no alpha in our numbers. It's just strictly numbers. What's the last name?
[CUSTOMER][POSITIVE] Awesome. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Is that [PII]?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] First name is [PII]
[AGENT][NEUTRAL] I'm not pulling up that name. Do you have the group number?
[CUSTOMER][NEUTRAL] Group number I have here is 6340.
[AGENT][NEUTRAL] I'm not pulling that up.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm. OK. Got it.
[CUSTOMER][NEUTRAL] OK just a moment here.
[CUSTOMER][NEUTRAL] And can we move to the next patient?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can we search for the member's name, uh, even I have incorrect member ID for this patient as well.
[AGENT][NEUTRAL] OK, what's the last name?
[CUSTOMER][NEUTRAL] It is [PII], that is [PII], sorry, [PII]
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] First name is [PII], that is [PII]
[AGENT][NEUTRAL] I'm not pulling up that name. What's the group number?
[CUSTOMER][NEUTRAL] Um, for this patient, I don't have the group number, ma'am.
[AGENT][NEUTRAL] OK, next policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] And here the next member ID.
[CUSTOMER][NEUTRAL] OK, just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, the next policy ID it is.
[CUSTOMER][NEUTRAL] 02312198
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is
[CUSTOMER][NEUTRAL] [PII] sorry [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] And date of service?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Date of service is [PII]. The amount is $2350 even.
[AGENT][NEUTRAL] Uh, it looks like the claim was.
[AGENT][NEUTRAL] Was received 4-17-2024.
[AGENT][NEUTRAL] Denied 4-182024, a member not eligible for benefits. Policy termed 1231-2023.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][POSITIVE] OK, got it. And I'm ready with the next patient.
[AGENT][NEUTRAL] OK, policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It is
[AGENT][NEUTRAL] You have the policy number?
[CUSTOMER][NEUTRAL] Um, sure, just a moment. Actually I'm not finding those number IDs.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] OK, ma'am, actually, uh, the remaining claims what I have, I don't have the correct member ID, so, uh.
[CUSTOMER][NEUTRAL] Once I receive the correct member ID or if I find anything I can call back, right?
[AGENT][POSITIVE] Yes, of course.
[CUSTOMER][POSITIVE] Mhm. Thank you. Thank you very much for patiently helping me.
[AGENT][POSITIVE] OK. Thank you for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You too, bye bye.