AccountId: 011433970860
ContactId: 80ceca8b-b666-400b-95f0-2b9d1c52c6a8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1025719 ms
Total Talk Time (AGENT): 168815 ms
Total Talk Time (CUSTOMER): 379243 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/80ceca8b-b666-400b-95f0-2b9d1c52c6a8_20250423T17:14_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, very good afternoon, [PII]. This is [PII] and initially my last name is [PII], and I'm calling from the provider's office to discuss with you on our claims.
[AGENT][NEUTRAL] OK, I can help with claim status. Could you spell your name for me?
[CUSTOMER][NEUTRAL] Uh yeah, my name is [PII], spelled as [PII] Last name initial is [PII]. And uh what's, can you, can you spell your name as well, please?
[AGENT][NEUTRAL] Yes, it's [PII]. It's [PII]
[CUSTOMER][POSITIVE] Thank you. Last name initial.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] That's great. Thank you, [PII] for that. And yes, [PII], let me, let me tell you this call has been recorded for quality and training purposes. uh, so is that OK with you?
[AGENT][NEUTRAL] Yes, that's fine. And do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Absolutely, uh, the policy number, it's gonna be just a second here I go. It's 0247.
[CUSTOMER][NEUTRAL] 4960 it's 4906.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] Sure, the patient's name, it's gonna be.
[CUSTOMER][NEUTRAL] It's Mac and Leslie and the date of birth is gonna be [PII].
[AGENT][NEUTRAL] OK, do you have the data service and build them out?
[CUSTOMER][NEUTRAL] Yes, I do have the date of service and build amount here, uh.
[CUSTOMER][NEUTRAL] OK, it's gonna be um [PII]. Total charge is $136. Uh, before you go ahead with the claim details, uh, [PII], I have already mailed the now I already made a call on the claim, uh, where I found the claim was paid, and this call is just to get the claim, I mean, uh.
[CUSTOMER][NEUTRAL] Yeah, so the paid EOB, um, I do have the claim number which under which the claim hasn't paid.
[AGENT][NEUTRAL] OK, that's 352-986-8.
[CUSTOMER][POSITIVE] Yeah, you're right.
[AGENT][NEUTRAL] OK. What's your fax number?
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Uh, how much time it will take to get the packs?
[AGENT][NEUTRAL] Uh, just like 2 minutes.
[CUSTOMER][NEUTRAL] Oh, that's great. Give me one second here. Yeah, it's gonna be [PII]. And please write uh attention towards my name, OK?
[AGENT][NEUTRAL] OK, uh, it should just take about 2 minutes.
[CUSTOMER][NEUTRAL] OK, this one was.
[AGENT][NEUTRAL] Oh, go ahead.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK, and what would be the call reference number for this patient?
[AGENT][NEUTRAL] It's just my name, [PII], last first initial and then my the today's date, sorry.
[CUSTOMER][POSITIVE] That's great, thank you very much for that, [PII], and I'm doing this thing here, um, this is for 29th account.
[CUSTOMER][NEUTRAL] Why am I doing so in this account, uh, OK.
[CUSTOMER][NEUTRAL] 29 is here and I got this thing from here.
[CUSTOMER][POSITIVE] Great, so next account number let me know whenever you're ready.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK. Do you have the next claim or uh policy number?
[CUSTOMER][NEUTRAL] Sure. The next policy number, it's going to be, I mean Delta 454009.
[CUSTOMER][NEUTRAL] 11.
[AGENT][NEUTRAL] OK, um, that's not one of our policy numbers. I can look it up by last name or social.
[CUSTOMER][NEUTRAL] Last name it's gonna be [PII]
[CUSTOMER][NEUTRAL] Let me see if it is not the number then what would be the.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, OK. It's the same.
[AGENT][NEUTRAL] Actually, it's a first name. Is there another name listed?
[CUSTOMER][NEUTRAL] [PII] is the last name of the patient. Oh sorry. Uh yeah. And the first name of the patient, it's going to be, [PII] mean, so the last name patient of his login, [PII]
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, give me one moment. I'm pulling it up.
[CUSTOMER][NEUTRAL] Mm sure.
[CUSTOMER][NEUTRAL] [PII] would be the date of birth.
[AGENT][NEUTRAL] OK. Um, have you checked on a claim on this one as well, or no?
[CUSTOMER][NEUTRAL] Yeah, we have already, uh, got the status for the claim, and here also the claim number ends with 3150 and I wanted to have the UOB able to be faxed as I have the details regarding the claims.
[AGENT][NEUTRAL] One.
[CUSTOMER][NEUTRAL] So for the first claim you have already sent it the you be on fax.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] OK, trying to see, uh, but it is not received it.
[CUSTOMER][NEUTRAL] I guess it will take time.
[AGENT][NEUTRAL] Mm let me see.
[AGENT][NEUTRAL] OK. What was the claim number on that?
[CUSTOMER][NEUTRAL] OK number was.
[CUSTOMER][NEUTRAL] Um, it was 3150 at the end, four digits.
[AGENT][NEUTRAL] You have the first three digits?
[CUSTOMER][NEUTRAL] Yeah, I do have the first three digits [PII].
[AGENT][NEUTRAL] OK, let's see
[AGENT][NEUTRAL] OK, and then same fax number?
[CUSTOMER][NEUTRAL] Same fax number.
[AGENT][NEUTRAL] OK, do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, I do have it is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Uh, it looks like it says it just sent, it was successfully sent.
[AGENT][NEUTRAL] The first one you refer.
[CUSTOMER][NEUTRAL] Uh, for the previous one? OK.
[CUSTOMER][NEUTRAL] Let me refresh my page.
[CUSTOMER][NEUTRAL] OK, we have received one here.
[CUSTOMER][NEUTRAL] Give me one second here. Attention to what's my name, company, P here. Yes, I received it. Thank you for this explanation of benefits. I do want you to have this one as well, and let me pull out the next date of service for the same patient, OK?
[CUSTOMER][NEUTRAL] Uh, it is for, for the same patient, the data service would be um.
[CUSTOMER][NEUTRAL] Yeah, it's [PII] for $136.
[AGENT][NEUTRAL] Do you have the claim number on that?
[CUSTOMER][NEUTRAL] Yeah, I do have the claim number. It's going to be 3.
[CUSTOMER][NEUTRAL] 563-788.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][NEUTRAL] OK, I'm just sending these right now. So hold on one moment.
[CUSTOMER][NEUTRAL] No, on this claim, uh, there is nothing to, uh, send actually, uh, I don't have the details regarding the claim. I got to know that this claim was denied as premium payment withholding, um, so.
[CUSTOMER][NEUTRAL] Is this claim paid?
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Uh, it looks like.
[AGENT][NEUTRAL] Data service was [PII]. The policy terminated.
[AGENT][NEUTRAL] On
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so you want to say that the claim was denied as the policy is terminated at the time of data service?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, can you have, can I have the receipt for the game?
[AGENT][NEUTRAL] I received date [PII]. Process [PII].
[CUSTOMER][NEUTRAL] OK, 2:14 and
[CUSTOMER][NEUTRAL] Claim Boston night as.
[CUSTOMER][NEUTRAL] She will stop.
[CUSTOMER][NEUTRAL] OK. And the effective date for the policy was
[AGENT][NEUTRAL] And it was, let me get that.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and the term date on?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Till [PII]. That's great, no problem. Is there any active policy or any renovation for the claim, I mean the policy for this patient?
[AGENT][NEUTRAL] Um, I don't show any other active policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Patient, OK. The call reference number for this patient is also your name and today's date, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, I'm left with one.
[CUSTOMER][NEUTRAL] OK. This last one.
[CUSTOMER][NEUTRAL] I guess they should be also paid if we have a detail for this one.
[AGENT][NEUTRAL] Is this a different patient?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, this is a different patient actually. Yes, this is a different patient. Uh, the data service, I mean, uh, the member ID number whenever you're ready.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] 02544684.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name it is going to be um [PII] um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and the date of birth?
[CUSTOMER][NEUTRAL] And the date of birth is, yeah, [PII].
[AGENT][POSITIVE] OK, thank you
[AGENT][NEUTRAL] Do you have the claim number on that one?
[CUSTOMER][NEUTRAL] Yeah, I do have a claim number um that's going to be.
[CUSTOMER][NEUTRAL] OK, so the claim number on this one it is 355-9115.
[AGENT][NEUTRAL] OK, you just need the EOB?
[CUSTOMER][NEUTRAL] No, no, no. Um, this claim, uh, first, let me know if the claim has been paid or not.
[AGENT][NEUTRAL] OK, status, um, received 29-2025.
[AGENT][NEUTRAL] Process 2:10.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Uh 29 2025 and process.
[AGENT][NEUTRAL] 210, 2025.
[CUSTOMER][NEUTRAL] 2:10. OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, it looks like we made a payment of $50.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] A lot.
[AGENT][NEUTRAL] Uh, it's a supplemental policy. It's not allowed. We just, we pay a certain dollar amount for the service. $50 was the payment amount.
[CUSTOMER][NEUTRAL] OK, is there
[CUSTOMER][NEUTRAL] Is there any patience responsibility on this claim?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility because this is a supplemental policy.
[CUSTOMER][NEUTRAL] OK, um, claim paid on.
[AGENT][NEUTRAL] 210, 2025.
[CUSTOMER][POSITIVE] 21. OK, that's great. And uh
[CUSTOMER][NEUTRAL] Uh, claim number would be the same?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, just a second.
[CUSTOMER][NEUTRAL] Payment method.
[AGENT][NEUTRAL] That's a single check.
[CUSTOMER][NEUTRAL] Go ahead with the single check number.
[AGENT][NEUTRAL] 202-683-2
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Check later on.
[AGENT][NEUTRAL] Um, let me check.
[AGENT][NEUTRAL] Uh, cleared on [PII].
[CUSTOMER][POSITIVE] [PII], that's great, um.
[CUSTOMER][NEUTRAL] It was paid to which address it is that American um Health Network for [PII].
[AGENT][NEUTRAL] Uh, yes, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] That's great. That's right. Uh, can you send me the one for this one as well on fax?
[AGENT][POSITIVE] Yes, I can get that.
[CUSTOMER][POSITIVE] That's great. um,
[CUSTOMER][NEUTRAL] Your reference number got it here.
[CUSTOMER][POSITIVE] OK, that's it then. Uh, I don't have anything further to discuss about the teams. Um, thank you very much, [PII], for providing all the details and I appreciate your patience. That's all for now and have a nice day. Bye.
[AGENT][POSITIVE] OK, thanks for calling APL you too bye bye.