AccountId: 011433970860
ContactId: 83131a39-4e7d-4a56-9183-5d929af5803a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 333589 ms
Total Talk Time (AGENT): 97311 ms
Total Talk Time (CUSTOMER): 131779 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/83131a39-4e7d-4a56-9183-5d929af5803a_20250303T19:57_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 OU Medicines.
[CUSTOMER][NEUTRAL] Can I have you spell your first name for me, please?
[AGENT][NEUTRAL] Sure, it's [PII]
[CUSTOMER][NEUTRAL] Thank you. Um, the reason I'm calling is I'm trying to get a status on a claim for data service of December of last year.
[AGENT][NEUTRAL] OK, yeah, I can check on that claim for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, policy number is 02268420.
[AGENT][NEUTRAL] OK, and then, uh, what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that [PII] and uh you said that was in uh December last year?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] [PII], OK, and then uh uh bill them out please.
[CUSTOMER][NEUTRAL] The bill amount, give me one moment. I can get that information for you.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The bill amount will be $12,932.26.
[AGENT][NEUTRAL] OK, $12,932.26.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Got it. OK, thank you. One moment, please.
[AGENT][NEUTRAL] OK, so we did receive this client [PII]. It looks like we are missing a copy of the primary EOB.
[CUSTOMER][NEUTRAL] So you need a copy of the itemized bill?
[AGENT][NEUTRAL] The primary, uh, explanation of benefits.
[CUSTOMER][NEUTRAL] OK, uh, and when did you receive this claim?
[AGENT][NEUTRAL] Uh, this was received [PII], and it was processed [PII].
[CUSTOMER][NEUTRAL] And you said it was processed on [PII]?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And what is the status of the claim? Like, has it been denied? Is it still processing or?
[AGENT][NEUTRAL] No, it has denied, um, but it can continue processing once we have that primary EOB.
[CUSTOMER][NEUTRAL] OK, so the reason it deny is because you don't have the primary ELB.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And do you guys have a fax number?
[AGENT][NEUTRAL] Yes, um, it is 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] And who is the attention to?
[AGENT][NEUTRAL] Claims department.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then once you receive that claim, how long does it take to finish processing?
[AGENT][NEUTRAL] It can take about 7 to 10 business days for claim information to complete processing.
[CUSTOMER][NEUTRAL] OK, I did try to look this up through you guys' portal, but for some reason it wasn't finding a member. Is there something wrong with the portal?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, not that I'm aware of. Uh, I know sometimes with providers you might have to have the claim number, um, and I can give that to you if you need it.
[CUSTOMER][NEUTRAL] No, I had the claim number when I was trying to uh register it. I don't know, it wasn't recognizing either the account number or the tax ID so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, I'm not sure.
[CUSTOMER][NEUTRAL] OK, so let's just reiterate, you said you received the claim on [PII] and it processed on [PII]. Claim denied due to no primary EOB being on file, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and your fax number is [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And then once you receive the information needed, it could take up to 7 to 10 business days to finish processing.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And do you have a reference number for today?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Um so my name is spelled [PII], last initial is [PII] And was there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] No, that was it. Thank you so much.
[AGENT][POSITIVE] Of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You as well. Thank you.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Right.