AccountId: 011433970860
ContactId: 93a32b37-4d32-439a-b1f6-678224568a40
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1057819 ms
Total Talk Time (AGENT): 220667 ms
Total Talk Time (CUSTOMER): 108551 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=-1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/93a32b37-4d32-439a-b1f6-678224568a40_20250617T13:12_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] I'm calling from a provider's office. I'd like to check on claim status, please, and I'm sorry, can I have your name?
[AGENT][NEUTRAL] Sure. My name is [PII]. That's [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] And you're welcome. May I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] May I have your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, Mrs. [PII]. And may I have the name of the facility you're calling from for my notes?
[CUSTOMER][NEUTRAL] Neuroscience and spine associates.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number, Miss?
[CUSTOMER][NEUTRAL] 02583412.
[AGENT][NEUTRAL] Hm
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Perfect, thank you. May I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] 224 2025 $212.
[AGENT][NEUTRAL] Yeah, thank you. Let me see if I can find this claim for you. And for future, you can check claim status online through our website at [PII], and that's just optional. You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me pull this and let me see if this is yours.
[AGENT][NEUTRAL] I'm waiting on the EMB to pull up.
[CUSTOMER][NEUTRAL] Yes OK
[AGENT][NEUTRAL] Alright, it looks like we processed the claim on [PII] and we send a benefit amount of $60 to the provider.
[AGENT][NEUTRAL] It looks like there was
[CUSTOMER][NEUTRAL] And that's for date of service 24.
[AGENT][NEUTRAL] 224 of 25, yes.
[CUSTOMER][NEUTRAL] It was the date of service 224 was processed 2-17.
[AGENT][NEUTRAL] 3:17.
[CUSTOMER][NEUTRAL] 3:17 OK got it sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And how much was paid?
[AGENT][NEUTRAL] $60.
[CUSTOMER][NEUTRAL] You paid $60?
[AGENT][NEUTRAL] Yes, we send the check for $60.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there patient responsibility?
[AGENT][NEUTRAL] Uh, we are the secondary. We're the secondary supplemental plan for the major medical. So there is one line item that did not cover, did not pay. Um, let me see why. Bear with me just a second.
[AGENT][POSITIVE] And it's because the major medical insurance provided full benefits for that one. So we went ahead and paid the only ones that they applied towards the member's responsibility.
[CUSTOMER][NEUTRAL] OK, what was the check number for that?
[AGENT][NEUTRAL] OK, that is 203-3374.
[CUSTOMER][NEUTRAL] And can you tell if it was cashed or not?
[AGENT][NEUTRAL] I can check. I'll have to research. Um, do you mind holding for me while I check on that?
[CUSTOMER][POSITIVE] That's fine thank you very much.
[AGENT][POSITIVE] You're welcome. Thank you. One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Miss [PII]. OK, um, can you verify the address for me?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you. Alright, so it looks like it's still outstanding, but it was sent to the correct address.
[CUSTOMER][NEUTRAL] Can you stop that check and reissue a new one?
[AGENT][NEUTRAL] OK, yes, it's been more than 60 days.
[AGENT][NEUTRAL] Let me go ahead and send that request, one moment.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold so I can complete this request. OK, one moment.
[CUSTOMER][POSITIVE] OK thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[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][POSITIVE] Thank you for holding and being patient for you, Miss [PII]. OK, I went ahead and send that report out for cancellation, OK? Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, can you please check on 2 other dates of service for the same patient?
[AGENT][NEUTRAL] OK, what is the next one?
[CUSTOMER][NEUTRAL] 328 2025 for $335.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] I'm waiting on the ERB on this one.
[AGENT][NEUTRAL] And we're checking for the same information to see if it's cleared.
[CUSTOMER][POSITIVE] Yes, oh yes, if, um, a check was sent, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm still waiting on the ELB. Bear with me.
[AGENT][NEUTRAL] OK. All right. So this one was processed on [PII].
[AGENT][NEUTRAL] And we send a benefit amount of $1.08.
[AGENT][NEUTRAL] OK, um.
[AGENT][NEUTRAL] Email address. OK. And it's still this one did clear this one cleared on [PII].
[CUSTOMER][NEUTRAL] Is there any patient responsibility?
[AGENT][NEUTRAL] Um, let me check the denials.
[AGENT][NEUTRAL] OK, for this one, we did deny the office visit because the office visit is not covered by this policy.
[AGENT][NEUTRAL] The rest versa.
[CUSTOMER][NEUTRAL] OK, so the $60 is the patient's responsibility because offices it's not covered.
[AGENT][NEUTRAL] OK, let me check the primary area and check and see if that was the amount. One moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so do do do 99.
[AGENT][NEUTRAL] 9212, yes, it looks like they apply $60 so yeah, that's, that's gonna be still membership.
[CUSTOMER][NEUTRAL] OK, alright then we don't have to check that last date of service I think it's the same thing.
[AGENT][NEUTRAL] OK, do you want me to check it or no?
[CUSTOMER][NEUTRAL] OK, can I just have a call reference number?
[AGENT][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] No, because I think it's the same thing because um it's the same $60 remaining and there's an office visit there.
[AGENT][NEUTRAL] Oh, got you. OK. All right, yes, we don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information, Miss [PII]?
[CUSTOMER][POSITIVE] No thank you very much for your help you were great I appreciate it.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You also bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.