AccountId: 011433970860
ContactId: 7aab58a1-d3ce-469a-9008-f92b4e4fa214
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1071819 ms
Total Talk Time (AGENT): 261927 ms
Total Talk Time (CUSTOMER): 301591 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/7aab58a1-d3ce-469a-9008-f92b4e4fa214_20250211T20:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, I have, uh, some information. I spoke with [PII] this earlier today, um, regarding the explanation of benefits I received where I, um, you guys requested more information from my clinic.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the, so what should we start with? Do you want my um date of birth or phone number?
[AGENT][NEUTRAL] Um, if you have a policy that would be great like a policy number I can pull up your info.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] OK, here it is, it is 02459557.
[AGENT][POSITIVE] All right, thank you so much. Give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] All right, and then if I could verify please your first last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, it's [PII] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And then I just need to verify the address on file, please.
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] All right. Thank you so much. OK, so I've got your uh policy pulled up, and so I see where you spoke with [PII] and she verified that you needed diagnosis codes, it looks like for the claim.
[CUSTOMER][NEUTRAL] Right, so one of my providers, Health View form or I'm sorry, M Health View Fairview, they're going to email me a PDF that I can fax off to you guys for um my let's see what date of service was that [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then um for service dates of [PII].
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, that's part [PII] and [PII]. When I talked to them, their supervisor said that that has to be requested from you guys. They won't give that to me, so they provided me with an email address and a fax number.
[CUSTOMER][NEUTRAL] Will you send the, the, I don't know, is it the CMS 1500 form?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] That you need, OK, yeah, they won't give that to me for some reason.
[AGENT][NEUTRAL] Yeah, what was
[AGENT][NEUTRAL] OK, and what was the date of service on that one again that they won't give it to you for?
[CUSTOMER][NEUTRAL] Um, it's for, uh, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the other date um is [PII].
[AGENT][NEUTRAL] [PII]. OK, and what is the email where we can send the request?
[CUSTOMER][NEUTRAL] OK it is contact customer service.
[CUSTOMER][NEUTRAL] One word
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you want the fax as well or just the email?
[AGENT][POSITIVE] Yes. Yeah, absolutely, go ahead.
[CUSTOMER][NEUTRAL] The fax is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You said your name was [PII], right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, [PII], sorry. OK.
[AGENT][NEUTRAL] That's OK. Yeah, it's spelled [PII]
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right [PII], so I've got that information here. I'm gonna place you on just a brief hold and see what we need to do to request this from them. I did you have any other questions or concerns before I place you on hold?
[CUSTOMER][NEUTRAL] No, I think that's it.
[AGENT][NEUTRAL] OK, all right, one moment please. OK.
[CUSTOMER][NEUTRAL] For now
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, maybe we don't use those anymore.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right thank you so much for your patience and waiting on that [PII]. I've got that request sent over and so um they should be getting that momentarily as far as the request for the additional information um you can follow up with them if you want later today um and then they can either fax it or mail it to us, whatever is convenient for them.
[CUSTOMER][NEUTRAL] OK, so you guys will contact [PII] [PII] and then they need to send the information.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The form to you guys, yep, OK.
[AGENT][POSITIVE] Yeah, yeah, absolutely, so and I I'll include the claim numbers and everything like that so yeah, and if they need anything from us they can definitely give us a call as well so.
[CUSTOMER][NEUTRAL] OK, um, going through my files here I found something else that it said insurance was pending.
[CUSTOMER][NEUTRAL] For a date of service of [PII], do you show anything like that on your end? I'm guessing that's maybe the hold up if they need more information. I haven't received an explanation of benefits so.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] So I do show a claim on file one for 7:30 of 24, but it was paid to the it was paid, it's not pending. I don't see her requesting any information.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It was paid.
[CUSTOMER][NEUTRAL] Uh, I wonder who did I pay it?
[CUSTOMER][NEGATIVE] I don't know who would've paid that. I'm confused.
[AGENT][NEUTRAL] Just meaning that the claim the benefit payment was made for the claim. The claim isn't requesting more information or anything like that, um.
[CUSTOMER][NEUTRAL] Did it show how much was paid?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Data service, uh, this is a bunch of dates.
[AGENT][NEUTRAL] So it looks like.
[AGENT][NEUTRAL] So it looks like there was a claim submitted for multiple dates of service. Um, there was $50 payment sent for that date of service of [PII], so.
[CUSTOMER][NEUTRAL] How much was that?
[AGENT][NEUTRAL] $50.
[CUSTOMER][NEUTRAL] $50.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $50 on a claim of $338.
[AGENT][NEUTRAL] Mm, mhm.
[CUSTOMER][NEGATIVE] I'm confused.
[CUSTOMER][NEUTRAL] Uh, I don't
[CUSTOMER][NEUTRAL] OK, so that that hasn't come across because I know I had talked to somebody, um, I don't know if it was that [PII] or [PII], but it said insurance was pending. Now you're saying it's closed?
[AGENT][NEUTRAL] I don't show that it, the claim status is showing that insurance is pending. If you're asking about this particular date of service where you were seen on [PII], I don't show where anything is pending, no.
[CUSTOMER][NEUTRAL] I, I don't, I don't understand. Did the insurance submit it to you or was it submitted to you?
[CUSTOMER][NEUTRAL] So I, I don't understand.
[CUSTOMER][NEGATIVE] I don't understand where the $50 who paid that?
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] The doctor or provider submitted a claim for that date of service of [PII]. The charge was, it looks like $338 insurance being APL paid $50 towards the office visit. The reason only $50 was paid.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Was because the calendar year maximum was exhausted with the payment of that claim, so there was nothing additional payable for that specific date of service.
[CUSTOMER][NEUTRAL] OK, I'm gonna have to call partner because I don't, you know.
[CUSTOMER][NEUTRAL] They're the ones that told me insurance was still pending, so I gotta find out what I owe on that.
[CUSTOMER][POSITIVE] Um, OK, APL paid 50. OK, alright, I'll check with them on that. Thank you so much, [PII].
[AGENT][POSITIVE] Yeah, not a problem. Is there anything else I can check on for you?
[CUSTOMER][NEUTRAL] Um, oh yes, actually, um, this is one that said insurance pending too, um, it's from [PII].
[AGENT][NEUTRAL] 107.
[CUSTOMER][NEUTRAL] It was for um yeah.
[AGENT][NEUTRAL] Yeah, they may be in the process of submitting something because I don't show any I don't show any claims on file for that date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty, OK, um, oh, let's see, can I check on just one more, please?
[AGENT][NEUTRAL] Uh-huh, yeah.
[CUSTOMER][NEUTRAL] Um, this one was for [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah, I don't show any claims on the file for [PII].
[CUSTOMER][POSITIVE] OK, alright. OK, alright, that's, this is probably all I can handle for one day. Thank you very much for all your help. I appreciate it.
[AGENT][POSITIVE] Yeah my pleasure, [PII], thanks for calling APL have a nice rest of your day.
[CUSTOMER][POSITIVE] Thanks, you do the same.
[AGENT][NEUTRAL] All right. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.