AccountId: 011433970860
ContactId: ab8d7e4f-0a49-456a-b688-bae11fede647
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 777400 ms
Total Talk Time (AGENT): 136680 ms
Total Talk Time (CUSTOMER): 264883 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/ab8d7e4f-0a49-456a-b688-bae11fede647_20250425T21:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, hi, this is [PII] calling from the product's office to check on the general claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] [PII] is the direct line.
[AGENT][NEUTRAL] The patient policy number?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh yes. It is 02465722 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] OK. The patient name is [PII].
[CUSTOMER][NEUTRAL] And it uh last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, what was that data service and bill charges?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the bill amount was $5,637 even.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, you said [PII], is that right?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, looks like um this is a term policy. Let me see if there's a new one.
[CUSTOMER][NEUTRAL] what
[CUSTOMER][NEUTRAL] Well it
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I didn't get this, sorry.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You're stating the term has been, sorry, the policy has been termed.
[AGENT][NEUTRAL] Yes, you gave me an old policy number. Let me look up a different policy number.
[CUSTOMER][NEUTRAL] OK, OK. So actually, I do have the claim number. Can you please verify with that claim number?
[AGENT][NEUTRAL] Uh yes, give me one moment.
[CUSTOMER][NEUTRAL] Sure, sure.
[AGENT][NEUTRAL] OK, what is that claim number?
[CUSTOMER][NEUTRAL] 349-6027
[AGENT][NEUTRAL] It looks like that was received 8-19-2024 processed 8-222024 and.
[AGENT][NEUTRAL] It looks like we need a copy of the primary EOB.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Need the primary, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Actually, we have sent it via fax multiple times. So did you receive it or not? I'll just verify with the fax number. Just let me know if that fax number is correct or not, OK?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] With, uh, yes, it is [PII]. Is this correct?
[AGENT][NEUTRAL] Uh, yes, let me see if we've received anything additional. Um, can I place you on a brief hold?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, go ahead.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, sorry about that. Yeah, it looks like the last claim that we received, let me pull up what we received.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm looking at it. Hold on one moment.
[AGENT][NEGATIVE] Uh, we, we, the EOB was not attached. We received the UBO4, the actual claim, but there was no EOB attached.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, the primary has been not attached, but you've got a UB04. Am I correct about this?
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, just give me a moment.
[CUSTOMER][NEUTRAL] OK. Just give me a moment.
[CUSTOMER][POSITIVE] May I get the call reference number for this call, and I do have more, uh, 3 claims with me. I that will be fine with you. We'll provide on one call.
[AGENT][NEUTRAL] OK, hold on one moment. Uh, call reference is my name, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Today's date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Just give me a moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. So I do have the different member ID with me. So, the member ID will be 01663489.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name will be?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII] and the last name is [PII] and the date of birth was [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] What is the date of service and bill charges?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, it was [PII] and the total bill amount was $6,354.35.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] Um, I don't show that. what was the birth date of the number you give that to me one more time.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, can I provide the numbers, uh,
[CUSTOMER][NEUTRAL] Claim number?
[AGENT][NEUTRAL] OK, is it?
[CUSTOMER][NEUTRAL] The same number will be?
[CUSTOMER][NEUTRAL] 3, just give me 356-633-8.
[AGENT][NEUTRAL] OK, uh, like we have a date of service at [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Just give me a moment.
[CUSTOMER][NEUTRAL] Received on [PII], right?
[AGENT][NEUTRAL] So that the date of service was [PII], that claim number you gave me, but you mentioned it in June, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh sorry, yes.
[AGENT][NEUTRAL] Um, so same was received.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Process 220 2025.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEGATIVE] And it looks like it was denied or.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Now we need a copy of the explanation about it.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Did
[CUSTOMER][NEUTRAL] OK, you need to be OK.
[CUSTOMER][NEUTRAL] So you gave.
[CUSTOMER][NEUTRAL] Oh, the fax number here. So may I know the mailing address, please? Oh, sorry, sorry, fax number you, you have gave, right? So that is the fax number we can.
[CUSTOMER][NEUTRAL] Take the same fax number, right?
[AGENT][NEUTRAL] Yes, same fax number.
[CUSTOMER][NEUTRAL] OK. We'll send that.
[CUSTOMER][NEUTRAL] Actually, we submitted multiple times. So can you please verify whether did you receive it or not? Because I here I can see we have sent.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh, I, the only thing we have on file is the claim number you mentioned, which did not have an EOB attached.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so I'm just going with the one last account.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We have
[CUSTOMER][NEUTRAL] OK, I do have the member ID 00266422.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] You need the member name and the date of birth?
[AGENT][NEUTRAL] Uh, it's pulling it up. Hold on one moment.
[AGENT][NEUTRAL] OK, can you repeat that policy number for me, please?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, it does just give a moment.
[CUSTOMER][NEUTRAL] It is 00266422 and.
[AGENT][NEUTRAL] I'm not pulling anything up under that. What's the last name?
[CUSTOMER][NEUTRAL] [PII] uh [PII]
[AGENT][NEUTRAL] The first name of the patient?
[CUSTOMER][NEUTRAL] It is [PII]
[AGENT][NEUTRAL] You have a claim number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, we don't have it.
[AGENT][NEUTRAL] OK, I'm not pulling up a name or a policy number or name that you provided.
[AGENT][NEUTRAL] I have to, do you have a group number?
[CUSTOMER][NEUTRAL] OK, you're stating that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, I do have the SSN. Uh, can you please find with that?
[AGENT][NEUTRAL] With the what?
[CUSTOMER][NEUTRAL] OK. It is [PII].
[AGENT][NEUTRAL] Um, that's not one of our group members.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, thank you so much for this information and have a great day ahead.
[AGENT][POSITIVE] OK, thanks for calling APL you as well. Bye bye.