AccountId: 011433970860
ContactId: 9a7414dd-1f8f-4e47-8281-ab2d13272547
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 858820 ms
Total Talk Time (AGENT): 261273 ms
Total Talk Time (CUSTOMER): 200157 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/9a7414dd-1f8f-4e47-8281-ab2d13272547_20250128T20:19_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] and calling from provider office to check on claim status.
[AGENT][NEUTRAL] OK. Did you say your name is [PII]?
[CUSTOMER][POSITIVE] Yes, perfect. It's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK. Yes, [PII], I can help you with claim status. And what is your callback number?
[CUSTOMER][NEUTRAL] Uh, callback number is just.
[CUSTOMER][NEUTRAL] It's [PII], sorry, sorry. It's [PII].
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] No, I don't have.
[AGENT][NEUTRAL] How many claims do you have to check status on?
[CUSTOMER][NEUTRAL] Uh, actually, I have only one claim.
[AGENT][NEUTRAL] OK. And you said your phone number is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Sorry, could you please repeat again?
[AGENT][NEUTRAL] Your phone number is [PII]?
[CUSTOMER][POSITIVE] Yes. Correct.
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. It's D as in Delta 476-088-38.
[AGENT][NEUTRAL] OK, thank you, but [PII], that is not a policy number for APL, that is a 90 degree benefit number. Does the number also have a policy with APL or were you just trying to reach 90 degree benefits?
[CUSTOMER][NEUTRAL] Uh, could you please transfer my call to, uh, correct department where we can discuss about my claim.
[AGENT][NEUTRAL] Again, who are you trying to reach? What company?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] What is the name of the company, [PII], that you're trying to reach?
[CUSTOMER][NEUTRAL] It's Mercy Hospital, Tiffin.
[AGENT][NEUTRAL] No, sir. What insurance company are you trying to reach?
[CUSTOMER][NEUTRAL] Uh, just a moment. I'm checking my system.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I can't see any information about that.
[AGENT][NEUTRAL] What phone number did you call today to reach me?
[CUSTOMER][NEUTRAL] Uh, I have called [PII].
[AGENT][NEUTRAL] OK, I'm not sure. What is your patient's name?
[CUSTOMER][NEUTRAL] The name is [PII].
[AGENT][NEUTRAL] What is the last name?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] First name is [PII].
[AGENT][NEUTRAL] Let me see if this member has a plan with APL also before I I transfer you since you're not sure what company you're supposed to be calling. One moment.
[CUSTOMER][POSITIVE] Mhm. OK. Just take your time, no issue.
[AGENT][NEUTRAL] OK, and any information that I provide would be a verification of benefits and not a guarantee of payment, [PII]. What is Mr. [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Are you asking about date of birth, correct?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so the member does not currently have an active policy with APL. What is the data service that you were calling for?
[CUSTOMER][NEUTRAL] OK. Could you please uh tell me for the effective and tell me the date of member.
[AGENT][NEUTRAL] First off, any information that is provided would be a verification of benefits and not a guarantee of payment. The most recent policy that this member had.
[AGENT][NEUTRAL] was
[AGENT][NEUTRAL] From [PII], and there has been no other coverage with our company since that point. What is your date of service?
[CUSTOMER][NEUTRAL] Uh, could you please tell,
[CUSTOMER][NEUTRAL] Uh, date of service is [PII].
[AGENT][NEUTRAL] Total bill amount?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, bill amount is $782 even.
[AGENT][NEUTRAL] And the correct policy number for the policy that he had at that time with APL is 239-6815.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And just one moment to see if there we have a claim on file for that data service.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you said it was for 782.782, is that correct?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, it's $7082.
[AGENT][NEUTRAL] $7,082 is that correct?
[CUSTOMER][NEUTRAL] Yes, correct. $7,082.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so this claim.
[AGENT][NEUTRAL] Was received by APL.
[AGENT][NEUTRAL] This claim was received. Give me just a moment, I'll provide you that information.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It was received on [PII].
[AGENT][NEUTRAL] Processed and denied on [PII].
[AGENT][NEUTRAL] And this claim was the claim number is 3379563.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And the reason for the denial states the calendar year maximum.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry, just one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The calendar year maximum for outpatient accident and sickness treatment in the emergency room has been met.
[CUSTOMER][NEUTRAL] OK. You mean to say member, uh, it's on uh members plan, correct?
[AGENT][NEUTRAL] Correct. It had already been met prior to this claim being received.
[CUSTOMER][NEUTRAL] Just a moment. I'm documenting this information.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Uh, May I know the uh member policy term is it?
[AGENT][NEUTRAL] 1029. Yes, sir, I gave you that a moment ago. It was effective 9-18-23, terminated 10-29-2023.
[CUSTOMER][POSITIVE] Effective and it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK. Uh, could you please fax us a copy of UV?
[AGENT][NEUTRAL] Can you access the internet? [PII], the easiest way to obtain that is by printing it directly from our portal.
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] I don't have access.
[AGENT][NEUTRAL] OK, so I'm, you don't have access to the internet?
[CUSTOMER][NEUTRAL] No, I don't have. I have fax number.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] 3
[AGENT][NEUTRAL] And what is your fax number, please?
[CUSTOMER][NEUTRAL] Yes, sir. Just a moment. Fax number is [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And does it need to be put to your attention? or is that not necessary?
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Yeah, sure. It's my name. It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm, OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, and I'm gonna repeat the fax number, [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yes. Yes, perfect.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] I don't.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] OK, so that explanation of benefits has been faxed to you, so provided that you're able to receive it, you should be receiving that very soon because it has been sent.
[CUSTOMER][NEUTRAL] Uh, how much time it will take to receive?
[AGENT][NEUTRAL] As long as it takes to transmit and your fax machine receive it again, it has been sent. I have sent it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, could you please tell me your name again?
[AGENT][NEUTRAL] [PII], my name in today's date will also be your call reference number.
[CUSTOMER][NEUTRAL] OK. What's the first initial of her last name, [PII]?
[AGENT][NEUTRAL] S and yours?
[CUSTOMER][NEUTRAL] Uh it's [PII].
[AGENT][NEUTRAL] OK. And is there anything else, [PII], I can help you with?
[CUSTOMER][POSITIVE] No, I'm done and thank you very much for giving me all the information.
[AGENT][POSITIVE] You're very welcome. And so that's all I can help you with. Thank you again for calling APL and I hope that you have a nice afternoon.
[CUSTOMER][POSITIVE] OK you too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.