AccountId: 011433970860
ContactId: 9657b8b4-a623-4d6e-80bd-f771a83b897f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 475190 ms
Total Talk Time (AGENT): 189259 ms
Total Talk Time (CUSTOMER): 103661 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/9657b8b4-a623-4d6e-80bd-f771a83b897f_20250127T14:27_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, this is [PII]. I'm calling from office to check on the claim status.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, I can help you with that. One moment please though, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] [PII]. And what were the last four numbers?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] Member ID number.
[AGENT][NEUTRAL] Mhm. What is the policy number so I can locate the member's information?
[CUSTOMER][NEUTRAL] Yeah, it's 02070759 M as in Mike, L as in Lima, 7.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and any information that I provide for you will be a verification of benefits and not a guarantee of payment. You will use my name that I gave you, [PII], as your call reference number along with today's date.
[AGENT][NEUTRAL] And if you need a copy of the of the explanation of benefits, if we have a claim on file, you may go to our portal at [PII] to print that.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] My first name is 10 and last name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Thank you and what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and total bill amount is $984 even.
[AGENT][NEUTRAL] OK, thank you. So I need to give you a different policy number first off. The policy number you gave me is an old policy number that has not been active since [PII].
[CUSTOMER][NEGATIVE] So the, so member ID is incorrect.
[AGENT][NEUTRAL] The that is correct for this state of service.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. Go on.
[AGENT][NEUTRAL] The correct policy number that you should have is 02263.
[AGENT][NEUTRAL] 406.
[AGENT][NEUTRAL] And that policy was active from [PII].
[AGENT][NEUTRAL] To [PII].
[AGENT][NEUTRAL] So give me just some.
[CUSTOMER][NEUTRAL] No, it's
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] It's not clear.
[AGENT][NEUTRAL] It, what, I'm sorry, what is not clear?
[CUSTOMER][NEUTRAL] Could you please, could you please repeat the date?
[AGENT][NEUTRAL] Effective [PII].
[CUSTOMER][NEUTRAL] Start an index.
[AGENT][NEUTRAL] Term date [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And give me just
[CUSTOMER][NEUTRAL] So, what was the status of the claim?
[AGENT][NEUTRAL] I've got to see if we have the claim on file. Just one moment. I had to locate the correct policy number first.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The system is still loading this information, so bear with me please [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and you said that again the day the service is [PII] dollars [PII] and the billed amount is $984. Is that correct?
[CUSTOMER][NEUTRAL] Uh, the date of service is [PII].
[AGENT][NEUTRAL] That is what I said.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The amount is $984 even, right?
[AGENT][NEUTRAL] OK, so we do not have a claim on file.
[AGENT][NEUTRAL] For this state of service and that bill amount.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. So, could you please provide me your pay ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK. Uh, and the member ID you told that 02263406. Is that right?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] That is correct. That is correct. And we must also have receive a copy of the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So you need the primary UB together.
[AGENT][NEUTRAL] That is correct, along with the claim.
[CUSTOMER][NEUTRAL] OK. Now, you don't have any primary UB?
[CUSTOMER][NEUTRAL] We have to send.
[AGENT][NEUTRAL] We don't, you have to send it with the claim.
[CUSTOMER][NEUTRAL] OK. Uh, and may I know your name, please?
[AGENT][NEUTRAL] [PII], and as I stated before, my name in today's date will be your call reference number.
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. Could you please spell it?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK. Um, thank you for your assistance. Have a great day.
[AGENT][POSITIVE] You're very welcome. Yes, sir. And is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No, thank you. Have a great day.
[AGENT][POSITIVE] OK, you too, and thank you again for calling APL Peter. I mean, I'm sorry, [PII], have a great day.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, Baba.
[CUSTOMER][NEUTRAL] Bye.