AccountId: 011433970860
ContactId: ab7619a7-e0b2-44b8-abab-db0a14bbc57e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 366929 ms
Total Talk Time (AGENT): 119781 ms
Total Talk Time (CUSTOMER): 146299 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/ab7619a7-e0b2-44b8-abab-db0a14bbc57e_20250326T18:47_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII], and I'm calling on behalf of Providence Health Alliance. I need your assistance on a claim.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, well I'll be more than happy to help you with the claim status and from my notes, can you spell your first name for me please and provide a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] My name is [PII], spelled as [PII].
[CUSTOMER][NEUTRAL] Provider name is Providence Health Alliance. Callback number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] IR 683-090-393.
[AGENT][NEUTRAL] Uh, hold on one moment. The phone broke up and I missed the beginning. Can you repeat that for me, please?
[CUSTOMER][NEUTRAL] Sure, no problem. It's FIR 683-090-393.
[AGENT][NEUTRAL] OK, do you have their, their secondary insurance policy or this is the only policy number you have?
[CUSTOMER][NEUTRAL] OK. So I do have another payer on the file. Let me see. That's IBA.
[AGENT][NEUTRAL] Um, I'm not familiar with that, but APL's policy number will start with a 01 or 02. It may have an ML 7 or 8 at the end.
[CUSTOMER][NEUTRAL] OK. Let me see if we have.
[CUSTOMER][NEGATIVE] So sorry, we don't have you.
[AGENT][NEUTRAL] OK, um, I can look the policy up with the member's social or if you have the claim number.
[CUSTOMER][NEUTRAL] Mm let me see if we have social, yes.
[CUSTOMER][NEGATIVE] Actually, we have received the uh rejection stating
[CUSTOMER][NEUTRAL] Unable to locate the claim or member?
[AGENT][NEUTRAL] Mhm. What's the claim number?
[CUSTOMER][NEUTRAL] So, with the social, uh, the social number is, hm.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You received the, you received a um
[CUSTOMER][NEGATIVE] We have not received.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Mhm. Please go ahead. Please go ahead.
[AGENT][NEUTRAL] I was trying to, I was trying to ask you, so you received an explanation of benefits from APL?
[CUSTOMER][NEUTRAL] No, uh, only a letter.
[AGENT][NEUTRAL] Is there a reference number on the letter?
[CUSTOMER][NEUTRAL] Mm, no.
[AGENT][NEUTRAL] Oh, well, there wouldn't be a reference number because the letter says there's no nothing was found, right?
[CUSTOMER][NEUTRAL] OK. Let reference number.
[CUSTOMER][NEUTRAL] No, it's the letter stating, I think this details are being requested from the member. But let me see. Do you have any additional information?
[CUSTOMER][NEUTRAL] So sorry I don't have any evidence for.
[AGENT][NEUTRAL] No, you're fine. Um, if you have the social, I can use it or I can try to search with the first and last name.
[CUSTOMER][NEUTRAL] Sure, uh, the social number is
[CUSTOMER][NEUTRAL] The whole social number or the last four digits?
[AGENT][NEUTRAL] The whole social.
[CUSTOMER][NEUTRAL] OK. So it's [PII].
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, I'm not showing a policy on file with the social, um, I can search with the name if you like, but it does, uh, what did the letter from APL say?
[AGENT][NEUTRAL] Do you have a copy of the letter?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes. The letter state and close information was submitted to APL. However, we are unable to locate the correct policy with the information provided. If you would like for, uh, if you would like us to further research our files, please send the following information, including a copy of the insurance ID card, any recent name changes. So I think this letter is being requested from the member. So, have you received any update from member regarding this?
[AGENT][NEUTRAL] Right, so no, we haven't. So that letter is saying we received the claim, but there's not, there's no policy here to match the information and they're asking, we're asking for the insurance card so that we can try to link it to a policy, but with the information provided there wasn't a policy. So once he gives that information, we'll be able to see if there is a policy here or let you know if it's not, but there's no policy here now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, no problem, [PII]. Thank you very much. Uh just go ahead with the call reference if we have any.
[AGENT][NEUTRAL] You're welcome, [PII].
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that would be all. Thank you very much.
[AGENT][POSITIVE] Alright, well thanks for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.