AccountId: 011433970860
ContactId: a3564684-5d19-4f98-8ed9-504749bdb4d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 330760 ms
Total Talk Time (AGENT): 148788 ms
Total Talk Time (CUSTOMER): 92837 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/a3564684-5d19-4f98-8ed9-504749bdb4d3_20250430T16:39_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]. I'm calling with Gwynette Pediatrics and Adolescent medicine. Um, I need to get some information on a claim that we sent out.
[AGENT][NEUTRAL] OK, [PII], you did say your name is [PII], is that correct?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK [PII], thank you, and you're needing or claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] OK, yes ma'am I can help you with that and what is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number please?
[CUSTOMER][NEUTRAL] I have 02607777.
[CUSTOMER][NEUTRAL] M like Mike L like Lima 7.
[AGENT][NEUTRAL] OK thank you one moment please while I get the member's information pulled up.
[AGENT][NEUTRAL] And calling 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 their date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And kindling any information that is provided again would be a verification of benefits and not a guarantee of payment. What is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] It was [PII] total bill amount was $557 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so we do not have a claim on file for her for that data service.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And you did say it's for [PII]? Is that correct?
[CUSTOMER][NEUTRAL] Yes, yes, ma'am. It is for [PII].
[AGENT][NEUTRAL] Yes, ma'am. There is.
[CUSTOMER][NEUTRAL] It looks like this may be our
[CUSTOMER][NEUTRAL] OK, um, are you able to verify that [PII] was active at that time at that data service?
[AGENT][POSITIVE] I can check that for you, yes, ma'am.
[AGENT][NEUTRAL] Mm, yes, ma'am. And let's see.
[AGENT][NEUTRAL] Um, just one second.
[AGENT][POSITIVE] Yes, ma'am. It does show that she's active.
[CUSTOMER][NEUTRAL] OK, um, and then if I could give you because it looks like it may have been our clearing house that kicked out, it looks like they're stating that um the provider may not be participating if I give you her NPI, would you be able to verify that she is participating?
[AGENT][NEUTRAL] Now with APL there is no network, it would follow her primary insurance, so I wouldn't be able to determine any of that because there's not a network affiliation with the supplemental policy. Now when you all do file the claim with us for her, we will also have to have a copy of her primary insurance company's explanation of benefits showing any amounts applied to copays, deductibles or co-insurance because this is a supplemental policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And then once we've processed the claim here at APL Collin, we do have a portal that you should be able to check our claim status in.
[AGENT][NEUTRAL] And the website for our portal is located at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, so you would need the primary EOB. It looks like we're probably just gonna have to mail this out.
[AGENT][NEUTRAL] Along with the claim.
[AGENT][NEUTRAL] Yes, and I can also give you our
[CUSTOMER][NEUTRAL] Along with the claim, yes ma'am.
[AGENT][NEUTRAL] I can give you our claims fax number if you would like.
[CUSTOMER][POSITIVE] OK, yeah, that would be great.
[AGENT][NEUTRAL] OK, it's 1877365.
[AGENT][NEUTRAL] [PII] attention claims department.
[CUSTOMER][NEUTRAL] Alright, and I have [PII]?
[AGENT][POSITIVE] That is correct, yes, ma'am.
[CUSTOMER][POSITIVE] All right, thank you so much. Is there a reference number for this call?
[AGENT][NEUTRAL] You would actually use my name along with today's date.
[CUSTOMER][POSITIVE] OK perfect thank you so much for your help we'll get this sent out to you.
[AGENT][POSITIVE] Well, you are certainly very welcome. So is there anything else that I could help you with at the moment, [PII]?
[CUSTOMER][POSITIVE] No, ma'am, that was it. I appreciate your time.
[AGENT][POSITIVE] Well, you're very welcome. It was my pleasure and thank you for calling APL. I hope you have a great afternoon.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.
[AGENT][POSITIVE] Yes ma'am, thank you, bye bye.