AccountId: 011433970860
ContactId: a724a5e5-2b3b-4b32-8030-0a0be24fe293
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 564909 ms
Total Talk Time (AGENT): 260742 ms
Total Talk Time (CUSTOMER): 163802 ms
Interruptions: 5
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/a724a5e5-2b3b-4b32-8030-0a0be24fe293_20250415T19:08_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling to see if you all received the claim from us.
[AGENT][NEUTRAL] OK, you're calling to check on claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you, and [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] 02456511
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And to trace 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] It is [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Uh, data services, it's a date range from [PII] for $32,0062.
[AGENT][NEUTRAL] OK, so just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it was 41 to 4:[PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes. Uh-huh.
[AGENT][NEUTRAL] And how much again?
[CUSTOMER][NEUTRAL] For $32,062 even.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] OK, so I don't, there's nothing for 41. So there was a data service on 41.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes, as far as I know, that's what it's saying.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So let me just look at um.
[AGENT][NEUTRAL] And again, what is the name of the facility or provider group?
[CUSTOMER][NEUTRAL] It is Anmed, A N M E D.
[AGENT][NEUTRAL] I'm not located a claim yet for those dates of service for this member with that billed amount.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Right. Let me look again 3.
[CUSTOMER][NEUTRAL] As a matter of fact, I think I.
[CUSTOMER][NEUTRAL] Worked on a claim from him earlier and the claim and I had to fax the um
[CUSTOMER][NEUTRAL] The claim
[AGENT][NEUTRAL] Because I don't see a claim for that bill amount.
[CUSTOMER][NEUTRAL] OK, I will fax that over. Um, let me see, did she give me a.
[CUSTOMER][NEUTRAL] She did this on the other one. OK, I will fax that over and.
[AGENT][NEUTRAL] Let me, let me, OK, let me just give me one more moment if you can but try to look at just a couple of additional things.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Do you have a breakdown or did you send that all together when you submitted it?
[AGENT][NEGATIVE] Cause I don't
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] I don't know. I don't have.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] I've searched several dates.
[CUSTOMER][NEUTRAL] Well, for this
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Mhm. No, go ahead. No, ma'am. Go ahead.
[CUSTOMER][NEUTRAL] Oh, I was just gonna say for this particular claim, um, it was mailed on, it was mailed back in [PII].
[AGENT][NEUTRAL] What address was it sent to?
[CUSTOMER][NEUTRAL] Um, let me look.
[CUSTOMER][NEUTRAL] It was sent to [PII].
[AGENT][NEUTRAL] Mhm. And when again was that mailed?
[CUSTOMER][NEUTRAL] It's been a while. Um, that was.
[AGENT][NEUTRAL] In tail
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yeah, no, ma'am. I don't, I'm not locating it for that bill amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. All right. I will, um.
[AGENT][NEUTRAL] But that is the correct, that is the correct address and I can also provide you our claims fax number and just make sure to include a copy of the primary insurance company's explanation of benefits as well, [PII], because we do have to have that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, would you like the claim fax number?
[CUSTOMER][POSITIVE] Yes, ma'am, I will do that.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, it is 1877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942-3 attention claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and that is [PII]?
[AGENT][NEUTRAL] Mhm attention claims yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] All right. And then once we do receive it.
[CUSTOMER][NEUTRAL] And include the primary EOP.
[AGENT][NEUTRAL] Correct, yes, ma'am, because we have to see the amounts applied to their deductibles, co-pay and co-insurance amounts since this is a supplemental policy.
[AGENT][NEUTRAL] And then [PII], you may already have this, but we do have a portal that you should also be able to check claim status in once we've processed the claim, and the website for that portal is secured. [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, to probably, you know, I try to use, I try to use the website and I click on new user and I click on I'm a medical provider. I hit next. I put in my tax ID and the patient account number and we, I, you can't get in.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Now the patient account number is that, OK, because, and I'm gonna ask you this because I get a lot of calls about it. On the patient account number, are you entering their APO policy number or are you entering the patient account number that you all have for the member because it's the provider's patient account number.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] Not their APO policy number.
[CUSTOMER][NEUTRAL] Uh, I
[CUSTOMER][NEUTRAL] Yeah, I'm entering the patient, the um account number that was assigned to the patient.
[AGENT][NEUTRAL] OK, well then I'm not sure I, and I do know that they are working on this portal as well, [PII] and making some adjustments and modifications and a lot of times I'm told that we may have the claim on file but you all aren't able to access it for whatever reason.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But if you call us and we give you the claim number, then with that claim number they are able to pull up the EOB.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, just keep that in mind as well. So I apologize that it's giving you trouble.
[CUSTOMER][NEUTRAL] Oh OK, OK.
[AGENT][NEUTRAL] It's supposed to make things easier, but.
[AGENT][POSITIVE] You know, we all know that technology can let us down like that sometimes, so I, I'm sorry about that.
[CUSTOMER][NEUTRAL] He
[CUSTOMER][NEGATIVE] Right, no, no problem. I, I, and I don't know why. I always try it and it always rejects me, so I end up calling anyway, but
[AGENT][NEUTRAL] Um, well, I'm so sorry, but you're welcome to call us anytime. And like I said, if we do have it, once you have the claim number, if we're able to provide that to you, then most of the time, you will be able to access that EOB then.
[CUSTOMER][POSITIVE] It's no problem.
[CUSTOMER][NEUTRAL] Yes fine.
[CUSTOMER][POSITIVE] OK. All right. Well, Ms. [PII], I do appreciate all your help today.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Well, you are certainly very welcome. And again, is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, ma'am, that was it.
[AGENT][POSITIVE] OK, [PII]. Well, thank you for calling APL and I hope you have a nice rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.