AccountId: 011433970860
ContactId: b0c34f1d-18de-4877-8632-179eaf5dbe7a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 377279 ms
Total Talk Time (AGENT): 173564 ms
Total Talk Time (CUSTOMER): 88245 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/b0c34f1d-18de-4877-8632-179eaf5dbe7a_20250115T15:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi [PII], my name is [PII]. I'm calling from OHH positions, and I was, um, calling to, I had faxed some claims in, um, I spoke to somebody on [PII], and I just wanna make sure that they were received or in processing.
[AGENT][NEUTRAL] OK, yeah, I can check on those claims for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And are all of these claims under the same policy number for the same number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, uh, did you have that policy number?
[CUSTOMER][NEUTRAL] Yes, it is 01986725.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK and uh what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Uh, [PII] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. Alright, and uh what were the dates of service uh for these claims, [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let's see I've got uh.
[AGENT][NEUTRAL] We could go one at a time if that's easier. I'm not sure how many you've got.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 812 of 24.
[AGENT][NEUTRAL] Uh, do you bill them out for that claim?
[CUSTOMER][NEUTRAL] Uh, $230.
[AGENT][NEUTRAL] 2:30. OK, thank you one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sorry, that was 8-12 of 2024, correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment. So I think, OK, but it might be under a different policy number. The one that you gave me, uh, terminated [PII]. Let me check this other policy number. Give me just a moment.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm sorry [PII], what was the name of the uh provider's office?
[CUSTOMER][NEUTRAL] OH physicians.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Bear with me just a moment.
[AGENT][NEUTRAL] OK, so I did find this claim, um, I don't know, did you want this uh updated policy number?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, it is 02462791.
[AGENT][NEUTRAL] And its effective date was [PII] and it is currently active.
[AGENT][NEUTRAL] Alright, and then so for this claim we were unable to pay a benefit uh as their family maximum for that for that benefit had been exhausted for the calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you want that claim number?
[CUSTOMER][NEUTRAL] So then all the ones after that would probably be the same.
[AGENT][NEUTRAL] Most likely I could still check to see if we've received them and get those exact answers for you. OK, so this claim is 354-5525.
[CUSTOMER][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alrighty and then uh what was that next date of service please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that building the mail?
[CUSTOMER][NEUTRAL] Uh, 300.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] OK, yes, so, uh, we'd received this one as well. The denial is the same as the family maximum for the benefit had been exhausted.
[AGENT][NEUTRAL] And let me know when you're ready for that claim number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] It is 354-552-6.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then 108 of 24.
[AGENT][NEUTRAL] OK, and what was that bill amount, please?
[CUSTOMER][NEUTRAL] $112.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] OK, yes, so this one we received it as well, and yes, the denial is the same, the maximum benefit had been exhausted.
[AGENT][NEUTRAL] Uh, so this claim number is 3545527.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then I have.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK I just have two more. There's a 10:15 of 24.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] 10:15 of 2024?
[CUSTOMER][NEUTRAL] Mhm, yes, for $150.
[AGENT][NEUTRAL] OK, I'm not showing we received that one.
[AGENT][NEUTRAL] I don't have a claim for that date of service.
[CUSTOMER][NEUTRAL] OK, so it was all in the exact the same fax and all came together.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] But it's basically gonna be the same, right?
[AGENT][NEUTRAL] I would imagine but uh yeah I'm I'm not showing we have a claim for 1015 of 24 for [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I'll go ahead and refax that one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just so we can get a proper denial with the claim number, OK, um, can I get a call reference number from you?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah, it would just be my first name, last initial, and today's date, and spell my name is spelled [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] No, I think that's all thank you so much.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you, bye bye.