AccountId: 011433970860
ContactId: ae2423f1-5594-4d67-9ad4-67f990d1a643
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 330739 ms
Total Talk Time (AGENT): 168962 ms
Total Talk Time (CUSTOMER): 109452 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/ae2423f1-5594-4d67-9ad4-67f990d1a643_20250130T19:14_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good afternoon [PII]. I'm calling from a provider's office to see if you have uh claims on file for a member.
[AGENT][NEUTRAL] OK, you're wanting to see if, uh, regarding, excuse me, you're calling about claim status for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes, ma'am, I can help you. And who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII]. It's spelled [PII]
[AGENT][POSITIVE] OK, I'm so sorry. Can you spell your name one more time, please?
[CUSTOMER][NEUTRAL] Of course, [PII]
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And pronounce it for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] To [PII], OK.
[CUSTOMER][NEUTRAL] So the
[CUSTOMER][NEUTRAL] $1100.
[AGENT][POSITIVE] Thank you. And so Hay, what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Thank you. And you have one patient that you're checking claim status on, is that correct?
[CUSTOMER][POSITIVE] Yes ma'am, that's correct.
[AGENT][NEUTRAL] OK, um, and what is the member's policy number, please?
[CUSTOMER][NEUTRAL] 01611814.
[AGENT][NEUTRAL] OK, thank you. And do you have more than one data service for this number or just one?
[CUSTOMER][NEUTRAL] I do. I, um, I have, I'll tell you right now how many dates. I think it's 4.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] It's 5 days.
[AGENT][NEUTRAL] For the same patient.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes ma'am. OK, I can help you. And so [PII], any information I provide for you on any of the claims today will be a verification of benefits and not a guarantee of payment. Also, you would use my name along with today's date if you need a call reference number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And lastly, if we do have the claims on file and you need any of the explanation of benefits, you may go to our portal to print those.
[AGENT][POSITIVE] And our portal website is secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. So, first off, um, what is your patient's name, please, and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII] and her date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So first off, what is the first data service and total bill amount for her place?
[CUSTOMER][NEUTRAL] OK, the first date of service is the um [PII], and the bill amount was $160.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK, so we do not have a, and again, I'm gonna re-verify [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, we do not have a claim on file on this supplemental policy for her for that data service.
[CUSTOMER][NEUTRAL] OK, um, you probably don't for the others, but I just wanna wanna make sure, um, the next date of service is [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Total bill amount?
[CUSTOMER][NEUTRAL] $160?
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK, I'm just gonna go ahead and and resend these in um.
[AGENT][NEUTRAL] OK, so on this, the, oh, I was sorry, I didn't wanna, you go ahead with your question or whatever you were gonna say and then I was gonna give you some information.
[CUSTOMER][NEUTRAL] Oh, no, no, go ahead, that's fine.
[AGENT][NEUTRAL] OK. All right. So this policy is a supplemental policy to her primary insurance. So because of that, um, so hey, we do have to have a copy of her primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Along with the claim for review and then again once we have processed our claim, you can go to that portal that I gave you at [PII] and you should be able to check claim status there. Now, now what were you about to ask me? Did you need any benefit information?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] No, ma'am, the only thing I wanted to know if there is a um a fax where we can fax the claims to along with that EOB.
[AGENT][NEUTRAL] Our claims fax number is [PII] attention claims.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][POSITIVE] All right, thank you very much for your help today.
[AGENT][POSITIVE] OK, well, you're certainly very welcome. So is there anything else that I could help you with?
[CUSTOMER][POSITIVE] No thank you have a wonderful day.
[AGENT][POSITIVE] OK. Well, you too, and thank you again for calling APL and I hope you have a nice afternoon also.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] You're welcome. Bye-bye.