AccountId: 011433970860
ContactId: 87df1578-cb69-44e9-82a3-bedffd98a132
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 482160 ms
Total Talk Time (AGENT): 223645 ms
Total Talk Time (CUSTOMER): 139534 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/87df1578-cb69-44e9-82a3-bedffd98a132_20250313T20:11_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, my name is [PII]. I'm calling from Multi-care, and I have a patient I'd like to get claim status on, please.
[AGENT][NEUTRAL] OK [PII], you have one patient you're needing claim status for, is that correct?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] My direct and secure line is [PII].
[AGENT][NEUTRAL] OK, thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] 2550129
[AGENT][NEUTRAL] Thank you, one moment, [PII], while I get the member's information pulled up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Any information that I do provide for you today, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] What is the last name?
[CUSTOMER][NEUTRAL] Um, hold on, let me look and see if she had a different last name at that time. [PII].
[AGENT][NEUTRAL] We have something that I just misheard you. OK.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] And what is the data service and total bill amount for her place?
[CUSTOMER][NEUTRAL] 9202024 through 921 2024 total bill amount $2,304 even.
[AGENT][NEUTRAL] $2,304 is that correct?
[CUSTOMER][NEUTRAL] And this is for a medical team.
[CUSTOMER][POSITIVE] Correct. Correct.
[AGENT][NEUTRAL] OK, one moment, and again you said 2304 is the bill amount.
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] OK, thank you and again any information that I do provide.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] And for you will be a very.
[CUSTOMER][NEUTRAL] Hello, I can't hear you.
[AGENT][NEUTRAL] OK, so the
[AGENT][NEUTRAL] Are you there?
[CUSTOMER][POSITIVE] I can hear you now. Yes, thank you.
[AGENT][NEUTRAL] You're welcome. So this claim has been received more than once, and the most recently received claim was denied as a duplicate. Do you need the original claim information?
[CUSTOMER][NEUTRAL] Uh yes, please.
[AGENT][NEUTRAL] OK, so the original claim was received on 11-12-2024.
[AGENT][NEUTRAL] And it was processed on 11-14-2024.
[AGENT][NEUTRAL] The claim number is 353-034-0.
[AGENT][NEUTRAL] And the remark on this claim.
[AGENT][NEUTRAL] States the denial reason as being the charges submitted are not payable because services were rendered prior to the policy's effective date.
[CUSTOMER][NEUTRAL] OK, policy effective date. And then when was her effective date for her medical?
[AGENT][NEUTRAL] Mhm, yes ma'am.
[AGENT][NEUTRAL] OK. This was effective as of [PII].
[AGENT][NEUTRAL] OK, it shows 9-23-2024 and term date of [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. Do you have a copy of that EOB you can send to me?
[AGENT][NEUTRAL] Yes, and, and you can actually print it directly from our portal now that you have the claim number.
[CUSTOMER][NEUTRAL] OK. And what is your portal?
[AGENT][POSITIVE] It is the website is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] But give me just one moment while I'm in it. I can, I can see if I can pull it up and and fax it to you. Just one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] American public.
[AGENT][POSITIVE] you might can get in there quicker and print it, [PII], and it's pulling up for me.
[CUSTOMER][POSITIVE] Oh good.
[CUSTOMER][NEUTRAL] And then the patient account number on there would be um their ID number, is that correct?
[AGENT][NEUTRAL] Whatever is, no, the patient account number is the account number in box. I don't know, is it 23 or 26 for you all?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh, what our account number is OK.
[AGENT][NEUTRAL] Correct. Yes, the patient account number, not the patient's policy number.
[CUSTOMER][NEUTRAL] 1794.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And I'm still waiting on my
[CUSTOMER][NEUTRAL] I haven't even started. I'm just registering.
[AGENT][NEUTRAL] Uh, OK, yeah.
[AGENT][NEUTRAL] Well, was the facts need to have your attention put on it, [PII], or is that not necessary?
[CUSTOMER][NEUTRAL] 69.
[CUSTOMER][POSITIVE] Um, if you could put my name, that would be great.
[AGENT][NEUTRAL] And is it [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] Oh, I like flickered. That's not a good sign.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Maybe I can go home though. That would work.
[AGENT][NEUTRAL] Ah
[CUSTOMER][POSITIVE] I'd be happy with that.
[AGENT][POSITIVE] I don't have much longer.
[CUSTOMER][POSITIVE] Well, I am home. I mean, I am home, not that, you know, not working. It would be perfect.
[AGENT][NEUTRAL] I understand. Yes.
[AGENT][NEUTRAL] Big difference, uh.
[CUSTOMER][NEUTRAL] Yes, there is.
[CUSTOMER][NEGATIVE] And my office is in my craft room, so it, it's like torture everyday sitting here. It's like, oh, what do you work on, you know? Oh man.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Alright, let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] But without the claim number you can still look it up on your portal, correct?
[AGENT][NEUTRAL] You should be able to, yes, if you have all of the other required information and we have the claim on file, then yes. What is your fax number, [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, I'm just gonna repeat that back. 2534597851.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I've gone ahead and faxed it to you and yes you should be if if you did not have the claim number but you had all of the other information it's asking for then yes now some people do have trouble without the claim number.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So again, you know, and of course if there's not a claim on file for the member under that patient account number and such as that, then it would not find it either.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, thank you. Um, do you have a reference number for today's call?
[AGENT][POSITIVE] Oh, you're welcome.
[AGENT][POSITIVE] Yes ma'am, you would actually use my name along with today's date.
[CUSTOMER][POSITIVE] Thank you so much. Have a great day.
[AGENT][POSITIVE] Well, you are certainly very welcome. And can I help you with anything else, [PII]?
[CUSTOMER][NEUTRAL] Nope, that was it.
[AGENT][POSITIVE] OK. Well, thank you again for calling APL. Have a great evening.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye