AccountId: 011433970860
ContactId: 919b2a9f-9e4c-4681-82fc-6aa7e43012f7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 749460 ms
Total Talk Time (AGENT): 241468 ms
Total Talk Time (CUSTOMER): 274048 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/919b2a9f-9e4c-4681-82fc-6aa7e43012f7_20250404T13:19_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APLAC. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office to check on a claim status.
[AGENT][NEUTRAL] OK, you're needing to check one claim status, is that correct?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, claim status.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that and could
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Can you spell your name for me please?
[CUSTOMER][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII] and your callback number, please?
[CUSTOMER][NEUTRAL] Yes, that is [PII].
[CUSTOMER][NEUTRAL] Extension 13113.
[AGENT][NEUTRAL] [PII], what was your extension again, [PII]? I'm sorry, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, your voice is cutting out some on my end. Your extension one more time, please?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And how many claims Pria do you have to check status on?
[CUSTOMER][NEUTRAL] I have one plan only.
[AGENT][NEUTRAL] 1
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, that's one thing.
[AGENT][NEUTRAL] OK, thank you. And what is that member's policy number?
[CUSTOMER][NEUTRAL] Sure. Member's policy number is 01894931 M as in Mike L as in Lima 8.
[AGENT][POSITIVE] OK, thank you. Give me a couple of moments for you to get the member's information pulled up, please.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And per anyation provided with a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] First name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the date of service and build amount please.
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII] and the bill amount is $345 even.
[CUSTOMER][NEUTRAL] Well
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so [PII], there is on this policy, this policy was not active for your data service.
[AGENT][NEUTRAL] Policy term 61 of 2024. Let me see if there is another policy that was active for your data service just one moment.
[CUSTOMER][NEUTRAL] Mm, but our data service is [PII]. You are told that the policy effective from
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. It means the member was still inactive, right?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] I told you that the policy termed 61 of 2024.
[CUSTOMER][NEUTRAL] Oh, sorry.
[AGENT][NEUTRAL] So there was another policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] See that is active with a different policy number. Let me put that in.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You know.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] right.
[CUSTOMER][NEUTRAL] Yes, I have the member ID for the previous call. Could you please verify the correct for the member ID the active policy.
[AGENT][POSITIVE] I'm going to provide that for you in just a moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the correct policy number that you should have for your date of service is 249.
[AGENT][NEUTRAL] 6871.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] With an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And um again, give me a moment to check to see if the claim was processed under the correct policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said that the claim was for $345. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so [PII], this claim was received on A [PII].
[AGENT][NEUTRAL] It was processed on 8 12-2024.
[AGENT][NEUTRAL] The claim number
[CUSTOMER][NEUTRAL] That means you do you have a claim on site?
[AGENT][NEUTRAL] It does under the correct policy number.
[CUSTOMER][NEUTRAL] Yes, please provide me that. I received it, please.
[AGENT][NEUTRAL] OK, I just gave you the received and processed date.
[CUSTOMER][POSITIVE] Yes, please repeat one more time. Sorry for that.
[AGENT][NEUTRAL] Prea, I'm sorry. I'm having trouble hearing you.
[CUSTOMER][NEUTRAL] Receive it please one more time.
[AGENT][NEUTRAL] Received 89, processed 8-12-2024.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3491445.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There was a benefit paid.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] In the amount of $192.43.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On single check, 186-7630.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is there any patient responsibility available?
[AGENT][NEUTRAL] Not determined patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] 1000.
[CUSTOMER][NEUTRAL] May I know the check, pay, issue date and cash date?
[AGENT][NEUTRAL] Issued [PII] cleared on [PII].
[CUSTOMER][NEUTRAL] Issued on [PII] and cleared on [PII], right? Could you please verify the pay to address?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]. OK.
[CUSTOMER][NEUTRAL] And could you please fax a copy of UB?
[AGENT][NEUTRAL] I can give you our portal website where you can print it.
[AGENT][NEUTRAL] Directly from our portal.
[CUSTOMER][NEUTRAL] Uh, no, we, we have, we don't have access for the reporter, so that's reason only.
[AGENT][NEUTRAL] And our portal website.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] Mm OK.
[CUSTOMER][NEUTRAL] No like no.
[AGENT][NEUTRAL] And [PII], does the facts need to be put to your attention once it loads?
[CUSTOMER][NEUTRAL] Yes. Yes, correct. Shall I provide a fax number once you're ready?
[CUSTOMER][NEUTRAL] Uh
[AGENT][POSITIVE] Not, yes, ma'am. I'll like I'm ready.
[AGENT][NEUTRAL] And again, your name is [PII] Is that correct?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think um.
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Because
[AGENT][NEUTRAL] OK. And your fax number, please?
[CUSTOMER][NEUTRAL] Yes, that is [PII]. Attention, my name.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Again, that is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] I'm sorry? Oh yes, correct.
[AGENT][NEUTRAL] Is that correct? The Foxer?
[CUSTOMER][NEUTRAL] Yes, sir. Yes, sir.
[AGENT][NEUTRAL] OK, so prior of that has been faxed, so provided there's not any issue with the fax going through, you should be receiving that very soon. And
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And, uh, the portal would be the next option if for any route received.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] It's a self-registering portal.
[CUSTOMER][NEUTRAL] OK. Please spell.
[CUSTOMER][NEUTRAL] OK. Please spell your name for my documentation purposes.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And my name will also be your reference number, [PII]
[CUSTOMER][NEUTRAL] And today's date, right? End of.
[AGENT][POSITIVE] That is correct, yes ma'am.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK. Thank you so much for your kind assistance. Have a great day.
[AGENT][POSITIVE] Well, you're very cool. Yes, ma'am. And if there's anything else I can help?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, I'm done with this. Thank you so much. Have a great day. Bye-bye. Have a great day. Bye-bye.
[AGENT][NEUTRAL] you with?
[AGENT][POSITIVE] OK. Well, I hope you have a, yes, ma'am. I hope you have a great day too, [PII] and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Mhm. OK.