AccountId: 011433970860
ContactId: 99ac51a5-0443-4435-bf23-f0284bfc1b9b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 372350 ms
Total Talk Time (AGENT): 148824 ms
Total Talk Time (CUSTOMER): 120137 ms
Interruptions: 2
Overall Sentiment: AGENT=1.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/99ac51a5-0443-4435-bf23-f0284bfc1b9b_20250505T14:39_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, [PII]. My name is [PII].
[AGENT][POSITIVE] Hi, [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Yes, I would like to check the status of a claim.
[AGENT][NEUTRAL] OK, you have one claim to track down a phone, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with that, and [PII], what is a good call back number for you please?
[CUSTOMER][NEUTRAL] Um, that will be.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] Policy number that is.
[CUSTOMER][NEUTRAL] 025.
[CUSTOMER][NEUTRAL] 06219
[AGENT][NEUTRAL] OK, thank you. One moment please while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, patient's name is, um,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And her date of birth?
[CUSTOMER][NEUTRAL] And date of birth is January.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her place?
[CUSTOMER][NEUTRAL] Yes, uh, the date of service is [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And the bill amount is for 4,644.
[AGENT][NEUTRAL] 4,644 even, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and you said the total bill amount is 3, I'm sorry, $4,644?
[CUSTOMER][NEUTRAL] Yes. Mhm.
[AGENT][NEUTRAL] OK, we do not have a claim on file for her for that data service and that bill amount.
[CUSTOMER][NEUTRAL] Let me see where did we submitted this claim to.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um, we send it to [PII].
[AGENT][NEUTRAL] 8950
[CUSTOMER][NEUTRAL] Let me see 8.
[CUSTOMER][NEUTRAL] 8950. Yes, yes, that's the
[AGENT][NEUTRAL] Correct. Mhm. And when was that sent?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Trying to see when was this at.
[AGENT][NEUTRAL] And what's the name of the facility?
[CUSTOMER][NEUTRAL] Um, it's McCloud.
[AGENT][NEUTRAL] Mhm, so we don't.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] McClouder Sea coast.
[AGENT][NEUTRAL] No, ma'am, we do not have that on file.
[CUSTOMER][NEUTRAL] And it was the mid.
[CUSTOMER][NEUTRAL] It was submitted on [PII].
[AGENT][NEUTRAL] No, ma'am, we do not, yeah, no claim on file.
[CUSTOMER][NEUTRAL] No claim on file. OK. Uh, and the patient was eligible during that time of service?
[AGENT][NEUTRAL] Yes. This policy became effective [PII].
[AGENT][NEUTRAL] Now, because this is a supplemental policy to her primary insurance, [PII], we will have to have a copy of her primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] Uh, it's 23.
[AGENT][NEUTRAL] And then, yes ma'am, and then once the claim has been processed by us, we do have a portal in which you should be able to check our claim status and our portal website is located at secured.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] A yeah, I, I was there [PII], but the claim didn't.
[AGENT][NEUTRAL] OK. Oh.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] That's because we don't have it.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's why you weren't able to locate it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Well, I'm gonna resubmit it um again. Um, did there's any way that I could fax it or something like that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, you can fax it to [PII] attention claims department.
[CUSTOMER][NEUTRAL] I said change claims department. OK, thank you.
[AGENT][NEUTRAL] Uh-huh. And just make sure to include that primary EOB. Well, you're welcome. So again, is there anything else that I could help you with today?
[CUSTOMER][NEUTRAL] I sure will.
[CUSTOMER][POSITIVE] No, that will be it thank you.
[AGENT][POSITIVE] OK, [PII], well you're very welcome and thank you for calling APL. I hope that you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye bye bye.