AccountId: 011433970860
ContactId: 90e4b51f-f5c2-4693-ae22-bd737c72cc31
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 424750 ms
Total Talk Time (AGENT): 165012 ms
Total Talk Time (CUSTOMER): 93257 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/90e4b51f-f5c2-4693-ae22-bd737c72cc31_20250213T15:29_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 [PII], I am calling um for claim status for a patient please.
[AGENT][NEUTRAL] OK, you have one patient that you're needing to check claim status for, is that correct?
[CUSTOMER][POSITIVE] That's correct, yes, it's just one.
[AGENT][NEUTRAL] Yes, ma'am, I can help you. Mhm. And who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] My direct callback number is [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] Her ID is 1071079.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hi [PII], any information that I do provide for you today 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]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the data service and total bill amount for him, please?
[CUSTOMER][NEUTRAL] [PII] total charges are $14,111 even.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And again you did say data services [PII] [PII].
[CUSTOMER][POSITIVE] That's correct.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] OK, so this was reissued on.
[AGENT][NEUTRAL] 2, I'm sorry, receive 2:10 and process the same date under claim number 356.
[AGENT][NEUTRAL] 1288.
[AGENT][NEUTRAL] And there was a benefit paid in the amount of $500.
[AGENT][NEUTRAL] That was paid on single check 202-6876.
[AGENT][NEUTRAL] And the remark on the claim states the maximum amount payable for this occurrence has been met.
[AGENT][NEUTRAL] Per-occurrence means treatment for the same or related condition unless separated by a period of 90 days. Treatment for the same or related conditions separated by 90 days or an unrelated condition will be considered a new per occurrence.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect and then um.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sorry, go ahead.
[AGENT][NEUTRAL] No, I was just gonna say, and if you need a copy of that explanation of benefits, you can print it, [PII], by going to our portal which is located at [PII].
[CUSTOMER][POSITIVE] OK, perfect. And
[CUSTOMER][NEUTRAL] This this was sent by mail, correct? I know it was just recently. It's just processed on the [PII], so we'll allow some extra time and the address that it was sent to, I just wanna verify that it was sent to our [PII].
[AGENT][POSITIVE] That is correct. Yes, ma'am. Uh-huh.
[AGENT][NEUTRAL] OK, let me pull up that information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Say the [PII] one more time for me, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No, ma'am. That is not what I show.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Did you send it to our physical address [PII]?
[AGENT][NEUTRAL] We have a 7412. No, it is a PO box, but there is.
[AGENT][NEGATIVE] And a a digit that doesn't match.
[AGENT][NEUTRAL] Give me just a moment to look at the claim.
[CUSTOMER][NEUTRAL] See here let's.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's taking time to load.
[AGENT][NEUTRAL] Apologize.
[CUSTOMER][NEUTRAL] Oh, it's OK.
[AGENT][NEUTRAL] OK, give me your PO box one more time, please.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that is, you had left off, I believe the 4 when you gave it to me a moment ago.
[AGENT][NEUTRAL] That you were missing one digit when you called it off to me, so that's why I said that's not, it's one digit off but yes, that is the 74124, yeah, 741249 is on the claim form and yes, that is the PO box that it was issued to.
[CUSTOMER][NEUTRAL] Oh, sorry.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Good.
[CUSTOMER][NEUTRAL] OK perfect um and then do you provide call reference numbers for our call today?
[AGENT][POSITIVE] Yes, you would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect thank you so much, [PII] you have a great day.
[AGENT][POSITIVE] Well, I hope you have a great day too, and if that's all I can help you with, [PII], then thank you again for calling APL.
[CUSTOMER][NEUTRAL] Uh huh bye bye.