AccountId: 011433970860
ContactId: 7d4c93b1-c1ca-4ccc-9078-e660f3d2a5e3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 727909 ms
Total Talk Time (AGENT): 250610 ms
Total Talk Time (CUSTOMER): 202974 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/7d4c93b1-c1ca-4ccc-9078-e660f3d2a5e3_20250513T15:16_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello [PII], this is [PII] calling from provider's office to check up on a claim status. Also, this call is being recorded for quality training purposes. Are you OK with that?
[AGENT][NEUTRAL] Yes, I'm fine with that. And how many claims do you have in total today?
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] I do have 4 claims with me.
[AGENT][NEUTRAL] And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it would be [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. Member's policy number would be 02563056 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] total charge $500 even.
[AGENT][NEUTRAL] I'm sorry, can you repeat the date of service?
[CUSTOMER][NEUTRAL] Uh, yeah, it's [PII] total charge $500 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, it's a diagnostic center for women LLC.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII]?
[AGENT][NEUTRAL] The claim number is
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 359-564-2.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, I can submit the primary GOB to you.
[CUSTOMER][NEUTRAL] Uh, can you help me with the fax number?
[AGENT][NEUTRAL] Sure, fax number is [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[AGENT][NEUTRAL] And that's attention
[CUSTOMER][POSITIVE] Thank you, um.
[AGENT][NEUTRAL] You're welcome. Did you need the attention?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's attention APL claims department.
[CUSTOMER][NEUTRAL] APL claims department.
[CUSTOMER][NEUTRAL] Thank you, can you help me with the call reference number for this one?
[AGENT][NEUTRAL] Yes, the call reference number for the entire call is going to be my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] You're welcome. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Are all the claims for the same member or there, there are multiple members?
[CUSTOMER][NEUTRAL] No, it's for the different members.
[AGENT][NEUTRAL] OK, just asking for the notes. And may I have the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The next
[CUSTOMER][NEUTRAL] Uh, policy number would be 02462268.
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima 8.
[AGENT][POSITIVE] Thank you and the member
[CUSTOMER][NEUTRAL] And actually I do have uh.
[CUSTOMER][NEUTRAL] Yeah, I do have 2 data services for this member.
[AGENT][NEUTRAL] OK. May I have the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have both dates of service and total bill?
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII]. Total charge $3500 even.
[CUSTOMER][NEUTRAL] And the next one is [PII], total charge $5000 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, so for both of those dates, there is no claim on file.
[AGENT][NEUTRAL] And that's [PII] and [PII]. Is that correct?
[CUSTOMER][NEUTRAL] No claim on file.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I just want to make sure, yes, there's no claims on file for those dates of service.
[CUSTOMER][NEUTRAL] OK, I just need to verify the mailing address. Is it [PII] City, OK [PII]?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. Can you just uh help me with the member's effective and term date?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] This policy was effective from [PII].
[AGENT][NEUTRAL] Actually, there's an active policy. Let me check that one. policy number 2597474 has been active since [PII]. So let me see if there's a claim on there. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] So for the [PII], um, date the policy, the claim was received on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim number is 359.
[AGENT][NEUTRAL] 5671.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim a total of $400.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you need any of the checking information?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so it was a single check?
[AGENT][NEUTRAL] Check number 204.
[AGENT][NEUTRAL] 1862, I'm sorry, 1826.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The check was mailed to [PII]. Is that the correct address?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, I just want to confirm because the um check is still outstanding. So if you do not receive the check by [PII], you can give us a call back and we can check on the check and reissue it if needed.
[CUSTOMER][POSITIVE] OK, sure, no problem. Thank you so much.
[AGENT][POSITIVE] You're welcome. And for the next
[CUSTOMER][NEUTRAL] Uh, can you, yeah.
[AGENT][NEUTRAL] Would you like to move to the next date?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So that claim was also received on [PII] for uh this is for [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The claim number is 359.
[CUSTOMER][NEUTRAL] I check again.
[AGENT][NEUTRAL] 5866.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] You're welcome. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Alright, the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The next policy number.
[CUSTOMER][NEUTRAL] It's 0245.
[CUSTOMER][NEUTRAL] 00
[CUSTOMER][NEUTRAL] 98 M as in Mike L as in Lima number 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, member's name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you for that and the date of service and the total bills.
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII]. Total charge $405 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the name of the provider's office on this claim?
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] It's the same.
[AGENT][NEUTRAL] I'm trying to receive the claim on [PII].
[AGENT][NEUTRAL] The claim number is 359.
[AGENT][NEUTRAL] 5646.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Requesting the explanation of benefits from primary insurance.
[CUSTOMER][POSITIVE] OK sure thank you.
[CUSTOMER][POSITIVE] Yeah, thank you so much for your help.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] That's it for the day.
[CUSTOMER][POSITIVE] Uh, no, thank you so much. That's it for the day. Hope you have a wonderful day.
[AGENT][POSITIVE] Thank you you also and thanks for calling APO. Bye-bye.
[CUSTOMER][POSITIVE] Bye-bye. Take care.