AccountId: 011433970860
ContactId: 91c47f52-888d-48fb-b27d-6d0a9c9e59ee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 796690 ms
Total Talk Time (AGENT): 215884 ms
Total Talk Time (CUSTOMER): 180807 ms
Interruptions: 5
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/91c47f52-888d-48fb-b27d-6d0a9c9e59ee_20250611T17:14_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] Hi [PII], my name is [PII]. I'm calling from the urgent care. I wanted to see if you guys have a claim on file for a patient that we treated in our office.
[AGENT][NEUTRAL] OK, well, I can definitely check and see if the claim's been received for you. And [PII], may I have a good contact number and the policy number?
[CUSTOMER][NEUTRAL] Yep it is [PII].
[AGENT][POSITIVE] Thank you and the policy number whenever you're ready.
[CUSTOMER][NEUTRAL] OK, it was, oh, didn't know when you were ready. OK, it is 257-879-994.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] Alrighty thank you.
[AGENT][NEUTRAL] You're welcome. And can you verify the members? Oh wait, hold on one moment.
[AGENT][NEUTRAL] And it was 257-879-994?
[CUSTOMER][NEUTRAL] That's what's here. If that doesn't work.
[CUSTOMER][NEUTRAL] I can give you a different number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's that's what's in our system, but when I pull up the card, there's a different number, but I think you guys got the claim before because there's a note in here saying that you guys were requesting our W-9 um in order to pay the claim, and then we sent that, so I, I don't know what what number the claim.
[AGENT][NEUTRAL] What's the number on the card?
[CUSTOMER][NEUTRAL] I don't know what
[CUSTOMER][NEUTRAL] OK, let's try that 785108.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's for [PII] and it is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So that was the correct policy number and may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh, 325 of 25.
[CUSTOMER][NEUTRAL] I'm not gonna get the total the total was 166.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that's what's going on. All right.
[AGENT][NEUTRAL] So this policy number, um,
[AGENT][NEUTRAL] That's on the card is no longer.
[AGENT][NEUTRAL] Active, but I see what was wrong with the first policy. So, the first number that you gave me, it's 257.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 879 4. So it had to either I put 2 or, yeah, so mhm.
[CUSTOMER][NEUTRAL] Oh, too many nights.
[AGENT][NEUTRAL] So let me open that one and then that's the active policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's been active since [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me see if there's a claim here.
[AGENT][NEUTRAL] OK, and [PII], do you mind if I place you on just a brief hold while I look at the claims?
[CUSTOMER][NEUTRAL] Mm mm no that's fine thank you.
[AGENT][NEUTRAL] You're welcome, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Mhm, yes ma'am.
[AGENT][NEUTRAL] All right. Thank you so much for holding. I apologize for the wait. OK, so I see the, the original reason for the denial. And you said you sent your W-9 in?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, when did it in and how did you send it in?
[CUSTOMER][NEUTRAL] Uh, it says.
[CUSTOMER][NEUTRAL] Um, let's see, sent W-9 and tax. I don't know if it must be the letter with our tax ID on it, um, to API. I don't, it, I don't know, I went back to the claims address or something back in April.
[AGENT][NEUTRAL] The reason I'm asking is because we haven't received anything. Um, so I was just trying to confirm how it was sent, make sure it was sent to the correct place. Um.
[AGENT][NEUTRAL] But the decision for the for this claim that you submitted was sent to the insured, um, but yeah, we haven't received it. Do you want to go over the claims, I mean, the mailing information just to make sure y'all have the right information?
[CUSTOMER][NEUTRAL] Sure, I mean there's, is there not a, I mean we can't fax it or email it or anything you guys just need it to go to through the mail?
[AGENT][POSITIVE] Yes, you can fax it.
[CUSTOMER][POSITIVE] Oh absolutely I'll get it right over to you if I can fax it that way I can get confirmation that you guys got it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure. It's 877.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942-3 and you know what, hold on one moment, let me make sure because with that I just wanna make sure it still goes to claims or if it's handled differently. Hold on one second.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] That's
[AGENT][POSITIVE] Alright hold on one moment I'm sorry about that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What happened to the fax number?
[AGENT][NEUTRAL] Hey uh.
[AGENT][NEUTRAL] We know.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, thanks again for holding. I apologize for that wait. So yes, there's a specific person um it goes to. So please disregard that fax number I gave you and I'm gonna give you the correct one.
[CUSTOMER][NEUTRAL] It's fine.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so it's [PII].
[AGENT][NEUTRAL] 539.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 3507.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And to the attention, [PII].
[AGENT][POSITIVE] With a good contact number for you all to be contacted um back at.
[CUSTOMER][NEUTRAL] And what's the, what's the last name [PII]?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, never heard that last name but OK.
[CUSTOMER][NEUTRAL] And ES OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, yep, alright, our information will be on there, um, and it's just the W-9 that's needed.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, do you think uh that will automatically link it to the claim, or should I send the claim with it as well?
[AGENT][NEUTRAL] No, no, no, because it's your um
[AGENT][NEUTRAL] Your group's information or your provider's information. So once we put your
[AGENT][NEUTRAL] Provider name and your tax ID in there, it'll link to your provider, not so much the claim. We're doing it for your provider.
[CUSTOMER][NEUTRAL] OK, but how, like, OK, so you get the W-9 and then I, I work my report again and this claim still is pending. Like how do I, how is this claim gonna get reprocessed once the W-9 gets loaded?
[CUSTOMER][NEUTRAL] That's what I'm saying like if you said it's not linked to the claim, how like uh do you understand what I'm asking?
[AGENT][NEGATIVE] Because once that comes up, anything that's been denied will show up under the provider.
[CUSTOMER][POSITIVE] Got you. So, OK, so kind of it well.
[AGENT][NEUTRAL] But if you like, you can add the claim number.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I don't, um, yeah, we can try.
[AGENT][NEUTRAL] Because they, they're gonna review, they'll review it, but you can add it. It doesn't matter if that if you rather have it than not need it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I mean, as long as the claim, no, yeah, but that I mean no I think you, I think you answered my question, but it's OK. I'm gonna send the information and hopefully the claim gets processed from there so that no that's fine. I'm just gonna get it faxed over in just a minute.
[AGENT][POSITIVE] Alrighty. Well, thank you so much for calling APL. Was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] No ma'am, that's all thank you for your help.
[AGENT][POSITIVE] You're welcome thanks for APL have a great day.
[CUSTOMER][NEUTRAL] Alright bye
[AGENT][NEUTRAL] Bye bye.