AccountId: 011433970860
ContactId: 902b177f-e854-4df2-a59b-de10d77fec06
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 744270 ms
Total Talk Time (AGENT): 277997 ms
Total Talk Time (CUSTOMER): 169016 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/902b177f-e854-4df2-a59b-de10d77fec06_20250507T18:21_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I was calling to check status of a couple claims for a patient.
[AGENT][NEUTRAL] OK, well, I can help you with the claim status, and may I have your name and a good contact number?
[CUSTOMER][NEUTRAL] My name is [PII] and my direct line is [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] I have 60801.
[AGENT][NEUTRAL] Oh, that's our payer ID. Do you have the card there?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah, why'd you put that in there. Let's see what's on the card here.
[AGENT][NEUTRAL] Uh, we're looking
[AGENT][NEUTRAL] Yeah, we're looking for the policy er number.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, I got it on here um 02550882.
[CUSTOMER][NEUTRAL] M for Mary, L for Lima 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] It's for outpatient.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh, hang on. Um, I will. The the card says.
[CUSTOMER][NEUTRAL] I own a Davis, but
[CUSTOMER][NEUTRAL] The patient I'm calling about is [PII].
[CUSTOMER][NEUTRAL] I have a date of birth of [PII]. I don't know if this is the right card that's hooked up to this person. I don't know. You tell me.
[AGENT][NEUTRAL] What's the name of the patient?
[CUSTOMER][NEUTRAL] Um, the patient's name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And then I have a date of birth of [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And did you want to give me all the dates of service at once or how do you want to do it?
[CUSTOMER][NEUTRAL] Um, I think there's two of them. The first one was on [PII].
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And it was for $360.
[CUSTOMER][NEUTRAL] And then the second one was on [PII].
[CUSTOMER][NEUTRAL] For $319.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And the second one was January, oh, sorry.
[CUSTOMER][NEUTRAL] Well [PII] must be the, she's the insured, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Obviously for [PII], OK, I just wanted to make sure that I have this the right card copy hooked up to this station.
[CUSTOMER][NEUTRAL] What did you ask me? I'm sorry?
[AGENT][NEUTRAL] The second date was [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on file?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Hold on one moment. 289.
[AGENT][NEUTRAL] So for the [PII] claim,
[AGENT][NEUTRAL] I will receive the claim on
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The claim number is 358.
[AGENT][NEUTRAL] 1289.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered on this policy.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then I'm getting a 2nd 1 now hold on one moment.
[AGENT][NEUTRAL] OK, now this one, we can't get the claim status on because the insured submitted this one.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh, we mailed the paper to you guys on [PII].
[AGENT][NEUTRAL] OK, hold on one moment let me see if it's more than one.
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Well, they all say the insured submitted it.
[AGENT][NEUTRAL] All the ones that came on the [PII] say that.
[AGENT][NEUTRAL] Well, it's probably easier to do this. Hold on.
[AGENT][NEUTRAL] Wait, oh here it is.
[AGENT][NEUTRAL] It's 0102 2025.
[AGENT][NEUTRAL] That's for the provider.
[AGENT][NEUTRAL] This one is provider 668. What else is the provider?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] That's the only one.
[AGENT][NEUTRAL] 356.
[AGENT][NEUTRAL] 256.
[AGENT][NEUTRAL] OK, hello [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] All right, thank you so much for holding. I apologize for that wait. So we actually received a few on that day or with that date of service. So I apologize for that. Um, but I did find the claim from you all. Um, we received it on [PII].
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Um, that claim number is 3569768.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim.
[AGENT][NEUTRAL] A total of $205.17.
[AGENT][NEUTRAL] It was a single check. Um, did you need the checking information?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, it was issued on [PII]. It was mailed to [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Zip code [PII].
[AGENT][NEUTRAL] Is that the correct address?
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Well, the PO [PII] is [PII], but.
[CUSTOMER][NEUTRAL] The city of [PII]. What, what did you say the zip code was?
[AGENT][NEUTRAL] Zip code I see is [PII].
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] Yeah, it should be going to Sun City. I don't know, um, that [PII] is a [PII] PO box.
[CUSTOMER][NEUTRAL] All of our PO boxes used to be in [PII], but now they're in in [PII], so uh that obviously.
[AGENT][NEUTRAL] So it's [PII].
[CUSTOMER][NEGATIVE] It's not get here.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] What's the name of the city?
[CUSTOMER][NEUTRAL] [PII], it's S for S[PII] and then city, so [PII], and then the zip code was [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this is what we're gonna have to do, um,
[AGENT][NEUTRAL] Let me look at what came in. I'm gonna, do you mind if I place you on just a brief hold? I wanna see if we need to
[AGENT][NEUTRAL] I'm trying to decide which document we need. Hold on one moment, OK?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Alright thanks.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, wait, wait, wait, wait, wait, wait, all the way a minute.
[AGENT][NEUTRAL] So I need to do this. I need to go to [PII].
[AGENT][NEUTRAL] And I need to.
[AGENT][NEUTRAL] 768.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Oh there it is.
[AGENT][NEUTRAL] OK, so 226.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh no, it's on here.
[AGENT][NEUTRAL] Oh, OK, so let me send this back. All right, I just had to check.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] All right, thank you so much for holding. So, after I, I was looking at the documents that were received, um, and the, the address that you gave is on here. So I'm gonna send this back to claims so that they can void this check and um reprocess it under the [PII] address because that is what's listed under the billing information.
[CUSTOMER][NEUTRAL] OK, what was the check number that originally was sent?
[AGENT][NEUTRAL] It's check number 203-0229.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so you'll have that one voided and then it'll be reissued to the same PO box with Siun City.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Cool, OK.
[AGENT][POSITIVE] And I'm definitely sorry for that, um.
[AGENT][NEUTRAL] That mix up. Was there um anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, is there a reference number for the call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date and again that's [PII]. First initial of my last name is [PII] like [PII].
[CUSTOMER][POSITIVE] Alright great alright thanks for all your help I appreciate it.
[AGENT][POSITIVE] You're very welcome, [PII]. Well, thanks for calling APL and I am gonna mark this urgent, so um hopefully they can get this done in the next 24 to 48 hours for you, um, and then you'll receive it, the explanation of benefits and everything.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] All right I appreciate it thank you.
[AGENT][POSITIVE] All right, you're welcome. Thanks for calling APL. Have a great day. Bye-bye.
[CUSTOMER][POSITIVE] Thank you you too.