AccountId: 011433970860
ContactId: a949ba6b-bcd0-4207-87ba-c5164c66bfb0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 282179 ms
Total Talk Time (AGENT): 111771 ms
Total Talk Time (CUSTOMER): 126457 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/a949ba6b-bcd0-4207-87ba-c5164c66bfb0_20250529T20:00_UTC.wav
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[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling you from provider office, and I'm looking for claim status.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim status, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm it's gonna be [PII].
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] I have 2 claims.
[AGENT][NEUTRAL] OK, and may I have the first member's policy number?
[CUSTOMER][NEUTRAL] Policy number, it's gonna be 9665643274.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so is that is not an APL policy number that may be their major medical. Do you have an APL ID card there?
[CUSTOMER][NEUTRAL] Wait, let me check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Is this the 1 02549426 [PII] [PII]?
[AGENT][NEUTRAL] And um the first and last name?
[CUSTOMER][NEUTRAL] First name is [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] Mhm. Date of service is [PII]. And the total bill amount, it's gonna be uh $484.74.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and are the other two claims for the same member? Are they different members?
[CUSTOMER][NEUTRAL] No, uh, that was for the first number which I gave you, but then as you say, that is not American public life, right, so I have only one this one.
[AGENT][NEUTRAL] Right. I'm asking you.
[AGENT][POSITIVE] Thank you. I'm asking you if I just want to know if this member had multiple dates of service so we can do them all together.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Um, so for this claim, we received it on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3,586,100.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, so, uh, so for this thing what I'm gonna do?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Um, so we don't
[AGENT][NEUTRAL] We don't determine patient responsibility here at APL. So for the outstanding balance, it would be um whatever your policies or procedures are.
[CUSTOMER][NEUTRAL] OK, uh, so I have to like, uh, bill to patient or what if it is not covered by policy?
[AGENT][NEUTRAL] That would be the
[AGENT][NEUTRAL] We do not determine patient responsibility, that's patient responsibility. So that's why it's not listed on the explanation of benefits.
[AGENT][NEUTRAL] So it would be up to you as the provider to determine if you write it off, if you build the patient, we can't tell you what to do.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. I, uh, could you, could you please check if, if the patient has other insurance or not?
[AGENT][NEUTRAL] We wouldn't have a record of that, ma'am. You would have to check with the member.
[CUSTOMER][NEUTRAL] OK. OK. Got it. OK. So, yeah. So, [PII], thank you so very much then. Uh, now, could you please provide me the call reference number for this member?
[AGENT][NEUTRAL] So the call reference number for the entire call will be my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, OK, so, and uh, yeah, thank you so very much for your help.
[AGENT][POSITIVE] You're very welcome. Did you have another claim or was there anything else I could assist with?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] Alright, well, thanks for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] Yeah, same ma'am. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.