AccountId: 011433970860
ContactId: 9008d25e-42d3-4bea-acb1-6b2c401d4dd0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 287899 ms
Total Talk Time (AGENT): 87327 ms
Total Talk Time (CUSTOMER): 134511 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/9008d25e-42d3-4bea-acb1-6b2c401d4dd0_20250124T13:08_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good morning. Uh, my name is [PII] from the provider office. I'm calling to check on claim status.
[AGENT][NEUTRAL] OK, I can help you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] It's, let me just sorry I need to pull it up.
[CUSTOMER][NEUTRAL] Yeah, um, policy number is 021-735999.
[AGENT][NEUTRAL] I'll get phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] I have here um [PII], and date of birth is [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And do you show the name of the policy holder?
[CUSTOMER][NEUTRAL] Um, let me just pull up the um.
[CUSTOMER][NEUTRAL] Patients.
[CUSTOMER][NEUTRAL] OK, just bear with me. I'll just open the card here.
[CUSTOMER][NEUTRAL] There you go. It is, I'm not sure if this is the one. It's [PII].
[AGENT][NEUTRAL] Is it [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's a Apple Hotel, Mary Echo Delta. Excuse me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And uh what is the date of service?
[CUSTOMER][NEUTRAL] I am looking for date of service [PII].
[AGENT][NEUTRAL] And the amount.
[CUSTOMER][NEUTRAL] Total bill amount, $267.
[AGENT][NEUTRAL] OK I show the office visit was not payable, um, it's not covered under the patient's policy. I'm showing that the claim was received.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] Processed [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me know when you're ready for the claim number.
[CUSTOMER][NEUTRAL] Go ahead, please.
[AGENT][NEUTRAL] Uh, that number is 352-095-0 and Roxy, you can also uh check your status on our online service center at [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I can help you set up that account if you, if you would like.
[CUSTOMER][NEUTRAL] Mm, yeah.
[CUSTOMER][NEUTRAL] Oh, I, I have already the account. However, when I checked this, um, member, it shows no claim on file. That's the reason I called. I don't know why, um, no claim on the file. Mm, OK. So, um, can I request a copy of EOB to be faxed for this?
[AGENT][NEUTRAL] Um, it actually was mailed, um, the day after it was processed. Um, I'm showing a date of birth of [PII] instead of [PII], and that's probably why you couldn't download it or locate it. So you may want to verify that with the with the parents and or the patient, and you can search for the explanation of benefits uh using the claim number that was provided.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, sure. I will try. Mhm. Mhm.
[AGENT][NEUTRAL] The date of birth
[AGENT][NEUTRAL] And the patient's first name.
[CUSTOMER][NEUTRAL] OK, the patient itself, I'm sorry, what is the um date of birth I should put on that for [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then the claim number. All right. I will try this. And so um this uh remaining balance, $89.98 would be the patient responsibility since um it is not covered.
[AGENT][NEUTRAL] Ma'am, we do not determine patients responsibility.
[CUSTOMER][NEUTRAL] Oh, I see. OK, sure. I'll go ahead and check that it will be on that portal. Thanks, [PII]. And yeah, I think that will be all for today. What about a reference number?
[AGENT][NEUTRAL] My name in today's date, [PII] last name is [PII] and anything else, [PII]?
[CUSTOMER][POSITIVE] Um, no, for now, thank you so much, [PII].
[AGENT][POSITIVE] You're welcome, thanks for calling APL. Have a good day.
[CUSTOMER][POSITIVE] You as well bye bye thank you.