AccountId: 011433970860
ContactId: 919831ba-275f-4d72-987c-16aacadaa134
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 491540 ms
Total Talk Time (AGENT): 200757 ms
Total Talk Time (CUSTOMER): 168996 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/919831ba-275f-4d72-987c-16aacadaa134_20250516T12:50_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Thank you for calling APO. Hi, [PII]. This is [PII] calling from provider's office to check on her client status. How are you doing today?
[AGENT][POSITIVE] I'm good sir and how are you today?
[CUSTOMER][POSITIVE] Yeah, I'm good thank you for asking.
[AGENT][NEUTRAL] Good. So you have one claim to check status on, is that correct?
[CUSTOMER][POSITIVE] Good.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am. I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] That is so I wanted to call back.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Number plate.
[CUSTOMER][NEUTRAL] Yes. The member's policy ID is
[CUSTOMER][NEUTRAL] 0246
[CUSTOMER][NEUTRAL] 715
[CUSTOMER][NEUTRAL] 5, M like Mary, L like Lima, number 8.
[AGENT][NEUTRAL] OK, thank you, sir. Give me a couple of moments please to get the member's information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and any information, [PII] that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Date of birth. It's
[CUSTOMER][NEUTRAL] Evenly
[CUSTOMER][NEUTRAL] [PII], it's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII] and the total charge amount for this claim is
[CUSTOMER][NEUTRAL] 174,210.
[CUSTOMER][NEUTRAL] Do even
[AGENT][NEUTRAL] 17 I'm sorry, 170.
[CUSTOMER][NEUTRAL] 17 I'm sorry 170.
[AGENT][NEUTRAL] Let me start over because.
[CUSTOMER][NEUTRAL] Let me start over because.
[AGENT][NEUTRAL] [PII], can you adjust your headpiece just a little bit because I'm hearing an echo of my voice.
[CUSTOMER][NEUTRAL] When can you adjust your head just a little bit because I'm hearing an echo of my voice.
[CUSTOMER][NEUTRAL] It's 174,210.
[AGENT][NEUTRAL] $174,210. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And there is no claim on file for this member for that data service.
[AGENT][NEUTRAL] And when you
[CUSTOMER][NEUTRAL] Actually, I have a claim number here.
[AGENT][NEUTRAL] You gave me a date of service of 8-1-2024. Is that correct?
[CUSTOMER][NEUTRAL] It's uh 354.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The claim number I have here is 3546727.
[AGENT][NEUTRAL] OK, [PII], that is not for the data service that you're giving me.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I need for you to verify the date of service.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. It's for the date range of [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so that claim number that you gave me was denied because we needed the primary insurance company's explanation of benefits, however, we only received the claim again.
[AGENT][NEUTRAL] And that was processed and denied under claim number 3561738 as a duplicate of previously submitted expenses.
[CUSTOMER][NEUTRAL] Sorry, could you please repeat the claim number again?
[AGENT][NEUTRAL] 354. I'm sorry, the duplic excuse me, the most recently received was claim number 3561738 and that was denied as a duplicate of previously submitted expenses.
[CUSTOMER][NEUTRAL] When do you receive this claim?
[AGENT][NEUTRAL] The received date of that claim was on [PII].
[AGENT][NEUTRAL] Uh, give me just one moment. It was received on [PII] and denied on [PII].
[CUSTOMER][NEUTRAL] OK. And do you have the original claim status?
[AGENT][NEUTRAL] Yes ma'am, you already have that too. It was denied because we were in need of the primary insurance company's explanation of benefits, and that is for the claim number that you gave to me.
[CUSTOMER][NEUTRAL] OK. And for this, we have already sent uh
[CUSTOMER][NEUTRAL] Primary OB to the mailing mail mailing address of [PII].
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm and that was submitted.
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Uh, we have not received that as of now.
[CUSTOMER][NEUTRAL] So, you never received any obese, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Do you have a fax number?
[AGENT][NEUTRAL] The fax number is [PII]. Attention claims department.
[CUSTOMER][NEUTRAL] OK. Let me repeat it. It's [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] No.
[AGENT][NEGATIVE] That is not correct.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] And it needs to be sent to attention attention claims department and if you need a copy of either of the explanation of benefits for the claim numbers that we've gone over now that you have the claim numbers you can print those from our portal if you go to [PII].
[CUSTOMER][POSITIVE] OK. Thank you for correcting me.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK. And could you please tell me the address, mailing address also?
[CUSTOMER][NEUTRAL] To send the EOB?
[AGENT][NEUTRAL] The same as the one you called off to me a while ago.
[CUSTOMER][NEUTRAL] OK. Thank you. And yeah, that's it. Could you please provide me the call reference number?
[AGENT][NEUTRAL] Yes, ma'am. It is my name along with today's date.
[AGENT][NEUTRAL] So [PII], that is all.
[CUSTOMER][POSITIVE] Thank you. Thank you for your time on that.
[AGENT][POSITIVE] You're welcome. Yes, ma'am. So again, if that is all I can help you with, thank you for calling APL and I hope you have a nice weekend.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] Wow
[CUSTOMER][NEUTRAL] [PII] um.