AccountId: 011433970860
ContactId: 80640a16-c872-42d0-9c7e-59aab991fe77
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 556669 ms
Total Talk Time (AGENT): 192312 ms
Total Talk Time (CUSTOMER): 203753 ms
Interruptions: 4
Overall Sentiment: AGENT=1.3, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/80640a16-c872-42d0-9c7e-59aab991fe77_20250210T20:07_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII]. I'm calling from provider's office uh to check whether the bill has been received for auto insurance claim.
[AGENT][NEUTRAL] OK, so you're trying to check this um claim status to see if we've received and processed a claim.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Yes, I can help you with that. And you said your name is [PII] Is that correct?
[CUSTOMER][NEUTRAL] Yes, I need to.
[CUSTOMER][NEUTRAL] Uh, this is [PII]
[AGENT][NEUTRAL] Oh, well, I'm sorry. OK, alright, thank you, [PII], and what is your callback number?
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Sure, thanks. No problem. That is [PII].
[AGENT][NEUTRAL] Thank you. And then, OK, and do you only have one patient that you're needing to check claim status on?
[CUSTOMER][NEUTRAL] Direct line.
[CUSTOMER][NEUTRAL] Yes, there is one, please.
[AGENT][NEUTRAL] OK, and what is that member's policy number?
[CUSTOMER][NEUTRAL] Uh, it's 01866995. M as in Mary, L as in Lima, and number 8.
[AGENT][POSITIVE] OK, [PII]. Thank you very much. One moment, please.
[CUSTOMER][POSITIVE] You're welcome, yeah, please take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], the information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth, please?
[CUSTOMER][NEUTRAL] OK, it is [PII]
[CUSTOMER][NEUTRAL] And uh date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her, please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure. That is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the total charges, sir, $6,556 even.
[CUSTOMER][NEUTRAL] That is 6556.00.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][POSITIVE] You're welcome, yeah.
[AGENT][NEUTRAL] OK, it said this claim was received back.
[AGENT][NEUTRAL] And one moment and I'll provide you that information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] This claim was actually received on 9-9-2024.
[AGENT][NEUTRAL] Processed and denied on 9-13-2024.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3504539.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this claim was denied because we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK. Thank you so much for this information, [PII]. So, uh, this has already been, uh, we received this, uh, information and the last conversation with one of the representative. Thanks so much. Uh, but, uh, as far as, uh, the documentation part, we have already sent the documentation, the requested documentation, the primary UB recently and we just like to confirm whether it has been received and if it has been received, then what is the process uh the status.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Well, you're welcome.
[AGENT][NEUTRAL] That's not being
[AGENT][NEUTRAL] Yes, so that's what, correct. We have not received that.
[AGENT][NEGATIVE] As of now, we have not received uh-huh, sure.
[CUSTOMER][NEUTRAL] OK. Just a moment. Let me just
[CUSTOMER][NEUTRAL] OK, fine, not a problem. Uh, let me just tell you, uh, share the details that when it has been resubmitted and uh we'll, we'll check on what exactly the status is. One moment, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] Oh, you're welcome.
[CUSTOMER][NEUTRAL] Yeah, [PII]. Uh, the last conversation that we had on the [PII]. That is the last week. So,
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We have got a fax number from your side that is [PII].
[AGENT][POSITIVE] That is correct. That is correct. Yes, it is. So give me.
[CUSTOMER][NEUTRAL] Is that correct? To send any EUB? OK. OK. So this has been, the EOB has been sent on this number on uh
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Just a moment, I'll tell you the date.
[CUSTOMER][NEUTRAL] It has been sent on [PII] at [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, just give me just a moment to let me look at something to see.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Yeah, sure, please. Go ahead, please. Thank you.
[AGENT][POSITIVE] Oh, you're welcome.
[AGENT][NEUTRAL] OK, so we have received it, but it has not yet been reviewed. The document itself was received?
[AGENT][NEUTRAL] And it's in line for review and there is not another claim number yet assigned to that document but it was received.
[CUSTOMER][POSITIVE] Thank you so much, uh, [PII]. May I know the date on which it has been received?
[AGENT][NEUTRAL] You're welcome. Mhm.
[AGENT][NEUTRAL] The [PII].
[AGENT][NEUTRAL] Did you get that information back? Did you hear what I said?
[AGENT][NEUTRAL] We received it on the [PII], yes, we received it on the [PII] and it is in line for review, but it has not been reviewed as of this moment.
[CUSTOMER][NEUTRAL] No, I did not hear. I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, I'm just noting it down so.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you so much, [PII]. And uh, by what time, what is the turnaround time we can expect for this to be get reviewed and processed?
[AGENT][POSITIVE] You are very welcome.
[AGENT][NEUTRAL] 7
[AGENT][NEUTRAL] Uh-huh. 7 to 10 business days.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Fine, thank you so much. I really appreciate your time and patience. May I have your call reference number, please?
[AGENT][POSITIVE] You are, yes, you're very welcome.
[AGENT][NEUTRAL] Sure, you're gonna use my name along with today's date and that, do you also have our portal website that you can check claim status?
[AGENT][NEUTRAL] Or print out EOBs. Our portal is secured. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] If you don't already have that.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] OK, it's secured, well, it's [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] As in [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] That is all from my end and uh
[CUSTOMER][POSITIVE] Thanks, thanks a lot for all your support. Uh, I, I'm just noting it down your call reference number as your name, [PII], and today's date for the reference. Thank you so much.
[AGENT][POSITIVE] Oh, well, you're very welcome.
[AGENT][POSITIVE] That is correct. Yes, sir. So if that's all Mac that I can help you with, and thank you again for calling APL and I hope you have a great afternoon.
[CUSTOMER][POSITIVE] You're welcome. You as well, and you have a very good day. Bye for now.
[AGENT][NEUTRAL] Yeah bye bye.