AccountId: 011433970860
ContactId: 87659323-0d6f-4266-9976-3485a31d77c0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 908309 ms
Total Talk Time (AGENT): 295249 ms
Total Talk Time (CUSTOMER): 165871 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/87659323-0d6f-4266-9976-3485a31d77c0_20250404T12:40_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. I'm calling on behalf of Professional surgical services, and I wanted to know if I could get a copy of two patients EOB.
[AGENT][NEUTRAL] OK, OK, so you're needing to get explanation of benefits for a member, is that correct? Or is it for two different patients?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's for two different patients and I would like to have it faxed if that's OK.
[AGENT][NEUTRAL] Yes, [PII], I can help you with this. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. In case any information that's provided today would be a verification of benefits and not a guarantee of payment. You will use my name and today's date as your call reference number for each. And what is your first patient's policy number?
[CUSTOMER][NEUTRAL] The first patient is 1153973.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] And your patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] What is the data service in total bill amount, [PII]?
[CUSTOMER][NEUTRAL] The date of service is [PII] with the bill amount of 346.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and you said data services 7-19 of 2024 for [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, now there is no claim on file for her with APL for that data service.
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] Second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, is it OK if we can move on to the next member then?
[AGENT][NEUTRAL] OK, now if you all will be filing, are you all gonna file this claim since it's not currently on file?
[CUSTOMER][NEUTRAL] Um, well, I won't be able to file. I don't have the EOB, so there I'll probably have to resend the.
[AGENT][NEUTRAL] OK, so when filing a claim with us on this type of policy, we will have to have a copy also of her primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed our claim KC here we do have a portal in which you should be able to check claim status and also print out our explanation of benefits.
[AGENT][POSITIVE] And our website for that portal is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Alright, thank you so much.
[AGENT][NEUTRAL] Yes ma'am, you're welcome alright and so is there any other information.
[AGENT][NEUTRAL] you need on this number?
[CUSTOMER][NEGATIVE] Um, not for this number, no.
[CUSTOMER][NEGATIVE] Not this.
[CUSTOMER][NEUTRAL] I remember and then I'll.
[AGENT][NEUTRAL] OK, all right, so one moment.
[AGENT][NEUTRAL] OK. And the next patient's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] It is 1246452 M as in Mary, L as in lion 4.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] What is the date of service and total bill amount for him?
[CUSTOMER][NEUTRAL] [PII] with the bill amount of 1,587.
[AGENT][NEUTRAL] OK, now, on this policy number that you gave me, it was not active for his data service. This policy number termed 111-2017. Let me see if he has another policy with us. He does.
[AGENT][NEUTRAL] So the correct policy number that you need to have you see is 014222777.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And again, this policy is active with an effective date of [PII]. So let me see if we received and processed your claim under the correct policy number.
[CUSTOMER][NEUTRAL] Can you repeat the correct policy number for me?
[AGENT][NEUTRAL] 142.
[AGENT][NEUTRAL] 22
[CUSTOMER][NEUTRAL] M42.
[AGENT][NEUTRAL] No, one.
[AGENT][NEUTRAL] 4
[AGENT][NEUTRAL] 2
[AGENT][NEUTRAL] 227.
[CUSTOMER][NEUTRAL] No 142-227.
[AGENT][NEUTRAL] 7.
[AGENT][NEUTRAL] So 14.
[AGENT][NEUTRAL] 22277.
[CUSTOMER][POSITIVE] Perfect thank you.
[AGENT][NEUTRAL] OK, alright, you're welcome. So just a moment please to see if the claim was processed under this policy.
[CUSTOMER][NEUTRAL] Um, so I have a question.
[AGENT][NEUTRAL] Yes, I'm look I'm still checking. Uh-huh, go ahead. I'm sorry.
[CUSTOMER][NEUTRAL] So for the last.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] For the last patient, you said that they need a copy of the primary insurance EOB. Do I send that together because I usually send them through mail if they aren't processed electronically. So do you want, you want a paper copy of the primary insurance EOB with the claim as well?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, because we have to have that since we are a supplemental policy that helps, you know, the.
[AGENT][NEUTRAL] Sees help with co-pays, deductibles and co-insurance amounts, primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] OK, OK, thank you.
[AGENT][POSITIVE] You're welcome. Uh-huh.
[AGENT][NEUTRAL] And I'm still looking for this data service for this bill amount. You said it was 1,587, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] This claim was received.
[AGENT][NEUTRAL] Uh, this claim received, was received on [PII].
[AGENT][NEUTRAL] It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 350.
[AGENT][NEUTRAL] 8049.
[CUSTOMER][NEUTRAL] Hey, can you repeat the claim number?
[AGENT][NEUTRAL] 3508049.
[AGENT][NEUTRAL] And the reason for the.
[AGENT][NEUTRAL] Denial states inpatient benefit for this calendar year has been met.
[CUSTOMER][NEGATIVE] Can you repeat why the claim was denied because you keep cutting off.
[AGENT][NEUTRAL] Inpatient benefit for this calendar year has been met.
[CUSTOMER][NEUTRAL] Um, do you need the fax number? So, um, you can send me the EOB.
[AGENT][NEUTRAL] So now that you have
[AGENT][NEUTRAL] Yes, ma'am. So now that you have the portal, do you still max it?
[CUSTOMER][NEUTRAL] I'm sorry, can you repeat that?
[AGENT][NEUTRAL] Now that you have our portal website, do you still need for me to fax it?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so just a few moments while that loads.
[AGENT][NEUTRAL] Will it need to be put to your attention, [PII]?
[CUSTOMER][NEUTRAL] Yes, put it to [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what is your fax number, please?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, again, that is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes, ma'am, that's what I said so.
[AGENT][NEUTRAL] Yes, ma'am. I have just sent that to you. So you should be soon. If for any reason you do not, then again, you can go to the website that I gave you for our portal and you should be able to print that yourself.
[CUSTOMER][POSITIVE] OK perfect thank you so much I appreciate your help.
[AGENT][NEUTRAL] OK. Well, you are certainly very welcome. And is there anything
[AGENT][NEUTRAL] Casey that I can help you with today?
[CUSTOMER][POSITIVE] No, ma'am, but I really do appreciate your help. Thank you so much.
[AGENT][POSITIVE] Well, you're very welcome and thank you again for calling APL. I hope you have a very nice weekend.
[CUSTOMER][POSITIVE] Thank you you as well bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.