AccountId: 011433970860
ContactId: 8f6d87f1-8068-4ddc-b12b-20ac22738afd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 815940 ms
Total Talk Time (AGENT): 321167 ms
Total Talk Time (CUSTOMER): 271114 ms
Interruptions: 5
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/8f6d87f1-8068-4ddc-b12b-20ac22738afd_20250122T13:57_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] Hi, good morning. My name is [PII] calling from provider's office, checking on claims. Uh, ma'am, can you repeat your name once again for me, please?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Got it. And uh [PII], may I know your last name? Mhm.
[AGENT][NEUTRAL] And yet
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] And uh [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And [PII], you said you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII], direct line, no extension.
[AGENT][POSITIVE] Thank you and how many claims, [PII], do you have today?
[CUSTOMER][NEUTRAL] Mm, 01 claim, only one.
[AGENT][NEUTRAL] OK. All right. And what is that member's policy number, please?
[CUSTOMER][NEUTRAL] It's going to be 02445904.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] And the information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. So one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And what is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] Patient's name, [PII]. Date of birth, [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the date of service and total bill amount please.
[CUSTOMER][NEUTRAL] I'm looking for date of service [PII] for the total charge $175 even.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] And.
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Actually, hold on just one moment, [PII].
[AGENT][NEUTRAL] This claim was actually received on [PII].
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Thank you
[AGENT][NEUTRAL] And it was processed on [PII].
[AGENT][NEUTRAL] This claim was denied. First off, the claim number is going to be 3457478.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] I think I think.
[AGENT][NEUTRAL] OK. And this, again, this claim was denied, [PII], and the reason for the denial.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] States
[AGENT][NEUTRAL] Our records indicate that premium for this service date was not received. Therefore, benefits are not payable.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This policy was active from [PII].
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] To its term date.
[AGENT][NEUTRAL] Of [PII], and there is no other active policy with our company.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] OK, uh, can you repeat the policy effective and term effective from to well.
[AGENT][NEUTRAL] Effective [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Term date [PII].
[CUSTOMER][NEUTRAL] [PII] after [PII].
[AGENT][NEUTRAL] Mhm. And then.
[CUSTOMER][NEGATIVE] Oh, but it's not active for the date of service.
[AGENT][NEUTRAL] That is correct, and there is no other coverage with our company active for the data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you need a copy of the of this explanation of benefits, you may print that by going to our portal [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][POSITIVE] [PII]. Mhm.
[AGENT][NEUTRAL] Uh-[PII].
[AGENT][NEUTRAL] [PII]. Yes, sir.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. I think I get needs to be registered on this.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] All right. Uh mm, OK. [PII], is there any possibility of uh sending your B to fax number?
[AGENT][NEUTRAL] You're not able to print it from our portal, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, I think I need to get registered on this one.
[AGENT][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, no, no, I wanna say.
[CUSTOMER][NEUTRAL] the
[AGENT][NEUTRAL] So it's still loading.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So I don't care.
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] I feel.
[CUSTOMER][NEUTRAL] Go on.
[AGENT][NEUTRAL] Will it need to be put to your attention once the information loads or is that not necessary?
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK fine.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. Uh, while I'm trying to register in this portal, in this step two, it's asking for the patient account number. Uh, if I need to check other patient.
[AGENT][NEUTRAL] That is the patient
[AGENT][NEUTRAL] Mhm. That is the provider, the account number that the provider has.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] It's not their policy number.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] What, what patient account number do you have for this number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I do say it's 2646401.
[AGENT][POSITIVE] Yes, sir, that is what we show as well.
[CUSTOMER][NEUTRAL] OK. So, if I register with this one patient account number, it will reflect for uh other patients as well, or I can check only for this one member only?
[AGENT][NEUTRAL] Once you register for that provider under that tax ID number if we have a claim on file.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You should be able to access it.
[AGENT][NEUTRAL] If it's for a different provider, you would have to register under that provider's tax ID also.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Mhm. And what is your fax number, [PII], and I'll send this to you.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] OK. It's going to be [PII]. Attention to my name, [PII], and the last name to the initial [PII].
[AGENT][NEUTRAL] Just one, OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, just one second, [PII]. I'm gonna have to try this again. So bear with me just a sec.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sure, no problem. Take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you may receive it, [PII], without your name on it, just her name and the policy number.
[AGENT][NEUTRAL] Uh, I think it's sent it before I could add your name on it. So give me just a moment. I'm gonna try to send it again with your name.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] OK, and you said that your fax number is [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so then
[AGENT][POSITIVE] Has been faxed to you [PII] so provided that um there's not any issue with it transmitting through you should be receiving that within the next few minutes.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] All right. Got it. Thank you.
[AGENT][POSITIVE] You're welcome and
[AGENT][NEUTRAL] Is there anything else I could?
[CUSTOMER][NEUTRAL] Mm, no, may I have the call reference number for the call, please?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] [PII], are you still there?
[CUSTOMER][NEUTRAL] Yes. OK.
[CUSTOMER][NEUTRAL] Can you help me with the call reference number for a call?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][NEUTRAL] OK, your name and the state.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Got it. Alright, [PII], that's it from my side. Uh, thank you so much for the information and time. Have a great great and lovely day ahead.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I
[AGENT][NEUTRAL] Uh, you're very welcome. And I just received uh a notification. I believe it's on the first fax that I was sent without your name, but it says that the line.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's busy.
[CUSTOMER][NEUTRAL] Uh, I didn't get you. I'm sorry, can you?
[AGENT][NEUTRAL] Fax number busy.
[CUSTOMER][NEUTRAL] Uh fax number?
[AGENT][NEUTRAL] No, sir. I faxed, you remember I said that I faxed it to you, you should get it twice. The first fax though that I have sent, I just received a a message on my computer stating that your line is busy, your fax line is busy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, maybe it will, uh, you know, a lot of facts will receive on my.
[AGENT][NEGATIVE] Yes, sir. It'll make. Yes, sir. It'll make 5 attempts to try and fax it before it will not try to fax anymore. It's, and I just received another one that says it's busy. So, and this one does say attention [PII], but again, it's showing your line as being busy and not able to receive it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me find.
[AGENT][NEGATIVE] And again, it will make 5 attempts. I just didn't want you to think that I didn't send it because I did. It's just having trouble being received on your end.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Oh, maybe a lot of facts are getting received from the other PS as but maybe that is the reason it shows uh line is busy. Uh, OK. Uh, can you do one thing? Can you try after sometime like after 5 to 10 minutes? Maybe I should get you.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Correct.
[AGENT][NEGATIVE] I, yes, I, you, you should be receiving it, but again, I don't know that I can fax it because of the way our calls come in. We have to take care of all, you know, when we're on a call with a customer, so, um, but again, I've attempted to send it multiple times. One says attention [PII], the other one did not. So you may receive this twice.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh yes, I do understand.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] All right then. Well, if that's all I can help you with, thank you again for calling APO and I hope that you have a very nice day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. I wish you the same. Bye-bye.
[AGENT][POSITIVE] Thank you very much. Uh-huh. Bye-bye.