AccountId: 011433970860
ContactId: a0484932-91ab-47de-b8ea-88bdb086e941
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 684190 ms
Total Talk Time (AGENT): 214898 ms
Total Talk Time (CUSTOMER): 184247 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/a0484932-91ab-47de-b8ea-88bdb086e941_20250221T15:12_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] Hello, [PII]. My name is [PII]. I'm calling on behalf of provider to check the claim status.
[AGENT][NEUTRAL] OK, [PII], uh, you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that, [PII]. And what is your callback number?
[CUSTOMER][NEUTRAL] Of course, the callback number is [PII]. Extension, yes, with extension [PII].
[AGENT][POSITIVE] Thank you. And [PII], how many, oh, I'm sorry, go ahead.
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you have to check status on today?
[CUSTOMER][NEUTRAL] Single claim
[AGENT][NEUTRAL] OK, yes, I can help you with that. And what is the member's policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 134.
[CUSTOMER][NEUTRAL] 951.
[CUSTOMER][NEUTRAL] 7 M as in March, L as in Lima, 8.
[AGENT][NEUTRAL] OK thank you one moment please.
[AGENT][NEUTRAL] And any information [PII] that I 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][POSITIVE] Yes of course.
[CUSTOMER][NEUTRAL] The patient name is [PII].
[CUSTOMER][NEUTRAL] And, and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII].
[CUSTOMER][NEUTRAL] And the total bill amount is $315.66.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so first off, [PII], this policy number that you gave me is an old policy that's no longer active. This policy was active from [PII].
[AGENT][NEUTRAL] To its term date of [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The correct policy.
[CUSTOMER][NEUTRAL] Can you
[CUSTOMER][NEUTRAL] Sorry for the interruption. Can you repeat again the
[CUSTOMER][NEUTRAL] Effected it?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the term?
[AGENT][NEUTRAL] 61 2019.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] There is another policy that is currently active with a different policy number.
[CUSTOMER][NEUTRAL] OK. Continue.
[AGENT][NEUTRAL] The correct policy number that you should have is 02496868.
[AGENT][NEUTRAL] This policy is active and it has an effective date of [PII].
[AGENT][NEUTRAL] And just one moment while I get that policy pulled up, please, [PII].
[AGENT][NEUTRAL] And again, you said the service date is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] What's
[AGENT][NEUTRAL] And the total bill amount was 31566, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so this claim was received on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] The claim number is 354-89990.
[AGENT][NEUTRAL] There was a benefit paid in the amount of $75.38.
[CUSTOMER][NEUTRAL] Paid amount was $75.38.
[AGENT][NEUTRAL] And if you can
[AGENT][NEUTRAL] And 38 cents. Mhm.
[CUSTOMER][NEUTRAL] OK. Continue.
[AGENT][NEUTRAL] And what is the address?
[AGENT][NEUTRAL] For mailing?
[CUSTOMER][NEUTRAL] For meeting.
[AGENT][NEUTRAL] Uh-huh, the payment, verify the address for the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No, so that's not the address. What is the name of the the facility?
[CUSTOMER][NEUTRAL] Forefront dermatology.
[AGENT][NEUTRAL] The clinic?
[AGENT][NEUTRAL] OK. That is not the claim, that is not the address on the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a second. And payment was done through check or EFT?
[AGENT][NEUTRAL] Single check.
[CUSTOMER][NEUTRAL] OK. So it was paid on [PII].
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What was the allowed amount?
[AGENT][NEUTRAL] $75.38. This is a supplemental policy only that helps with co-pays, deductibles and co-insurance amounts of covered services.
[CUSTOMER][NEUTRAL] OK. Allowed amount was 75.38 and the paid amount was 75.38.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Can you provide me the check number?
[AGENT][NEUTRAL] 2021964.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a second, please. Let me check once.
[CUSTOMER][NEUTRAL] Uh, can you provide me the check clear date?
[AGENT][NEUTRAL] The check is still outstanding as of this point?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And it was mailed to the address that we received on the claim.
[CUSTOMER][NEUTRAL] She
[CUSTOMER][NEUTRAL] OK, just a second, check.
[CUSTOMER][NEUTRAL] Can you verify the address?
[AGENT][NEUTRAL] Yes, so I ask you, yes, sir. Uh-huh. Go ahead.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, I will spell it. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Yes, sir, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, what is the check clear date?
[AGENT][POSITIVE] Again, this check is still outstanding at this time.
[CUSTOMER][NEUTRAL] OK, just a second.
[CUSTOMER][NEUTRAL] So, can you reissue the check?
[AGENT][NEUTRAL] I can send a request to have it verified that it is indeed still outstanding and request that it be reissued.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] So we have to send again request.
[AGENT][NEUTRAL] No, sir, you don't send anything. I said I would send a request.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this typically takes 7 to 10 business days.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits, you may get that by going to our portal which is located at [PII].
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. 7 working days.
[AGENT][NEUTRAL] 7 to 10 business days.
[CUSTOMER][NEUTRAL] OK, 7 to 10 business days.
[CUSTOMER][NEUTRAL] So, can you provide me the call reference number?
[AGENT][NEUTRAL] Yes, it would be my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] [PII] 0221222025.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And is there anything else that I can help you with today, [PII]?
[CUSTOMER][POSITIVE] Mm, no, it's enough. Thank you. Thank you for providing me the information. It was very helpful for me.
[AGENT][NEUTRAL] OK, well, you will
[AGENT][POSITIVE] You're very welcome, [PII]. It was my pleasure. So if that's all I can help you with, thank you again for calling APL and I hope you have a great weekend.
[CUSTOMER][POSITIVE] You also have a great weekend. Bye-bye.
[AGENT][POSITIVE] Thank you, bye bye.