AccountId: 011433970860
ContactId: 8878185f-fc46-4e35-8d0f-f4bb37855397
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 333649 ms
Total Talk Time (AGENT): 124595 ms
Total Talk Time (CUSTOMER): 117622 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/8878185f-fc46-4e35-8d0f-f4bb37855397_20250513T17:57_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah. Hi, [PII]. My name is [PII]. Uh, I'm calling from Pro's office to check on the claim status.
[AGENT][POSITIVE] OK, I could check on a claim for you. I'm so sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] Uh, yeah, it's uh [PII], that's [PII].
[AGENT][NEUTRAL] Got it. OK, have you, can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] Thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] Uh, yeah, I do. The policy number is, just a moment.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah. It's uh 01699664. M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] My name is [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Yeah, it's for [PII].
[AGENT][NEUTRAL] [PII] and then do you have that bill amount?
[CUSTOMER][NEUTRAL] Yeah, for $3,234.
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, now [PII], that amount that you gave me, is that before or after major medical, uh, paid?
[CUSTOMER][NEUTRAL] Uh, OK. And that is uh before medical paid. Uh, after medical paid, it's only $35.
[AGENT][NEUTRAL] 55.
[CUSTOMER][NEUTRAL] No, no, 35, 35.
[AGENT][NEUTRAL] 35. OK, OK, thank you. And then do you have the um pay uh excuse me, the tax ID uh for this provider please?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK thank you one moment please.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, so I do see that we've received several claims for the state of service from this provider. However, I don't see that we've received any for those amounts, [PII].
[CUSTOMER][NEUTRAL] Uh, actually, I kind of have this. I don't know whether this is correct or not. Uh, I have the claim number 3.
[AGENT][NEUTRAL] Sure, uh, what was that claim number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's, it's showing 3590119.
[AGENT][NEUTRAL] 119. Let's see.
[AGENT][NEUTRAL] Alright, one moment, let me get that pulled up.
[AGENT][NEUTRAL] OK, so that is looking like that will be for that um it doesn't look like we've received the primary EOB for this, but let me check and see because it is showing that original amount so I apologize um let me see these notes here.
[AGENT][NEUTRAL] OK, so I guess either way we would be unable to pay a benefit. Habib as office visits are not covered under this policy, uh, nor is service, uh, or treatment received in office.
[CUSTOMER][NEUTRAL] So, is it showing like a patient responsibility?
[AGENT][NEUTRAL] No, so we don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] Yeah, um, because, you know, if it is like a patient responsibility, I can like, you know, check with the patient whether they can pay or not. But is it any other way I can like, you know, like, you know, submit a corrected claim to be processed this one?
[AGENT][NEUTRAL] Sure.
[AGENT][NEGATIVE] Unfortunately not, Habib, as again office visits and treatment received in office is simply not covered under this patient's policy.
[CUSTOMER][NEUTRAL] Patient policy. All right. Uh, just help me with one last information. Do you know this patient's plan type?
[AGENT][NEUTRAL] This is a secondary medical policy.
[CUSTOMER][NEUTRAL] um.
[CUSTOMER][POSITIVE] I see. Sure, then. I'll, I'll check with member regarding this one, no issues. And then, uh, and
[AGENT][NEUTRAL] OK, sure. Did you have any other questions for me?
[CUSTOMER][NEUTRAL] Uh, he, yeah, just help me with the call reference number.
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial [PII]'s date, and so my name is spelled [PII], last [PII]
[CUSTOMER][POSITIVE] All right. Go on to it. Right. And, you know, thanks for helping me with this information, OK. Yeah, I'll check with the number regarding with it.
[AGENT][NEUTRAL] Of course, yeah, please call APL.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][POSITIVE] Yeah. Thank you. Have a good day. Uh, no, no, I'm just saying, sir. Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes sir, of course, thank you, bye bye.
[CUSTOMER][NEUTRAL] Bye now.