AccountId: 011433970860
ContactId: 8728b0a8-95c7-4294-acf7-abe76ab11a73
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 803030 ms
Total Talk Time (AGENT): 157099 ms
Total Talk Time (CUSTOMER): 172949 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/8728b0a8-95c7-4294-acf7-abe76ab11a73_20250422T17:40_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling AP this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, my name is calling. My name is [PII] calling from provider's office. How are you doing today?
[AGENT][POSITIVE] I'm doing well how are you?
[CUSTOMER][POSITIVE] Yeah, I'm doing great. Thank you for asking. It's for claim status. Can you please help me out?
[AGENT][NEUTRAL] Yeah, I can check on a claim for you. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] Yes. So, it's spelled as [PII].
[CUSTOMER][NEUTRAL] And last name [PII].
[AGENT][POSITIVE] OK, thank you for that. [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII] the direct line.
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, before I proceed, this call may be recorded for quality and training purpose. Would you like to continue?
[AGENT][NEUTRAL] Uh, yeah, that's fine.
[CUSTOMER][NEUTRAL] Yeah, the, the member ID will be 01.
[CUSTOMER][NEUTRAL] 699452 M as in Mike, L as in Lima, and 8.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] [PII] and the date of birth will be?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK thank you for verifying that and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], give me just a moment.
[CUSTOMER][NEUTRAL] And the the bill amount is?
[AGENT][NEUTRAL] Uh, go ahead. I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, bill amount is $197 even.
[AGENT][NEUTRAL] That was $197?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK thank you one moment please.
[AGENT][NEUTRAL] OK. Uh, was this with skin, um, and cancer associates?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] With the provider is that skin and cancer associates?
[CUSTOMER][POSITIVE] Yes, yes, yes, yes.
[AGENT][NEUTRAL] OK, OK, so we did receive this claim, uh, we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I know the claim number?
[AGENT][NEUTRAL] Yeah, that's 357 6.
[AGENT][NEUTRAL] 554.
[CUSTOMER][NEUTRAL] Uh, may I know the received and the processed date?
[AGENT][NEUTRAL] Yes, so this claim was received [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] On the same date, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, just a moment. So where we can get the EOB.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I can send that to you. Do you have a fax number?
[CUSTOMER][NEUTRAL] Uh, no, is there any provider portal?
[AGENT][NEUTRAL] Uh, yes, we do have a website if you prefer that.
[CUSTOMER][NEUTRAL] OK. Can I get
[AGENT][POSITIVE] Yes, uh, so the web address, it's secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You said the claim number is 3576554, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I'm just checking.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] But I did not get any claim for this patient.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEGATIVE] I am unable to get.
[CUSTOMER][NEUTRAL] OK, I got it. Uh.
[CUSTOMER][NEUTRAL] Yeah. Can you please, yeah, can you please uh
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Say another patient
[AGENT][NEUTRAL] Oh, what was that? I'm sorry?
[CUSTOMER][NEUTRAL] Yeah, can we proceed with another patient.
[AGENT][NEUTRAL] You have another client we need to look at?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, and this was for a different member?
[CUSTOMER][NEUTRAL] Yeah, it's a different number.
[AGENT][NEUTRAL] OK, uh, one moment, I'll let you know when I'm ready for uh that information.
[AGENT][NEUTRAL] OK. Uh, you can go ahead and give me that next policy number.
[CUSTOMER][NEUTRAL] Yeah, I do not have a policy number. Can you please check with patient name and the date of birth?
[AGENT][NEUTRAL] Um, I can't search with the date of birth. Um, if you would, could you spell out the first and last name for me?
[CUSTOMER][NEUTRAL] Yeah, first name of the patient will be [PII] and the last name will be [PII]
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And then what was that date of birth for uh this member?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. um, what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, and then, uh, what was that bill amount please?
[CUSTOMER][NEUTRAL] $197 even.
[AGENT][NEUTRAL] OK, and again, I'm sorry, that was [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Of [PII], correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, uh, I'm not showing that we've received a claim for that date of service for this member.
[CUSTOMER][NEUTRAL] Uh, OK. Is the patient is active?
[AGENT][NEUTRAL] Um, yes, they did have a, a policy that was active at that time. Uh, whenever you're ready, I can give you that policy number.
[CUSTOMER][POSITIVE] Yes, I'm ready.
[AGENT][NEUTRAL] That is 02.
[AGENT][NEUTRAL] 15.
[AGENT][NEUTRAL] 36
[AGENT][NEUTRAL] 21
[CUSTOMER][NEUTRAL] 02153621, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, and the payer ID will be 60801, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So we need to review the claim again.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK. Can you please proceed with another patient?
[AGENT][NEUTRAL] Uh, yes, give me just a moment, I'll let you know when I'm ready for that.
[AGENT][NEUTRAL] OK. Uh, you can go ahead and give me that next, uh, policy number.
[CUSTOMER][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] 02103443
[AGENT][NEUTRAL] I'm sorry, could you repeat that?
[CUSTOMER][NEUTRAL] 02103443
[AGENT][NEUTRAL] OK and then uh what was the name and date of birth for this number?
[CUSTOMER][NEUTRAL] [PII], and the date of birth will be [PII].
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello. Hello, hello, hello.
[CUSTOMER][NEUTRAL] Hello, hello, hello.