AccountId: 011433970860
ContactId: b445cb0f-aed5-4c7d-8ee6-aba71dbba9f8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 409019 ms
Total Talk Time (AGENT): 156266 ms
Total Talk Time (CUSTOMER): 101985 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/b445cb0f-aed5-4c7d-8ee6-aba71dbba9f8_20250514T13:50_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, hi, sir. My name is [PII]. I'm calling you from provider's office to check your claim status.
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status, Ms. [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And may I have um the name of the facility you're calling from for my notation?
[CUSTOMER][NEUTRAL] It's endodition LLC.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] It's uh the Delta number 433-02090.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you see any other policy numbers for this member, Ms. [PII]?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] And you said it's 433-02090?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah that's too many numbers to be one of our policy numbers. Is this with APL, American Public Life?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yes, there's too many numbers to be one of our policies. Um, what other information do you have on the number that I can use to locate?
[CUSTOMER][NEUTRAL] Are
[CUSTOMER][NEUTRAL] Uh, but I've already called to you and I spoke with you as well, and you provide me the status of this claim.
[AGENT][NEUTRAL] What information do you have from the last call? Because that's the information I'm gonna need.
[CUSTOMER][NEUTRAL] Uh, the claim was denied for any special benefit.
[AGENT][NEUTRAL] OK, what's the number of the claim?
[CUSTOMER][NEUTRAL] Your last name initial [PII]?
[AGENT][NEUTRAL] Correct. What is the claim number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's 3561913.
[AGENT][NEUTRAL] 6191. You said 3561913?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. OK, let me pull the policy number with that.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Ms. [PII], let me give you the correct policy number. You don't have a correct policy number.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] The correct policy number is 02.
[AGENT][NEUTRAL] 47
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 49.
[AGENT][NEUTRAL] 24.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And what is the date of service? Is it the same date of service that um we discussed earlier, or is it a different one, Ms. [PII]?
[CUSTOMER][NEUTRAL] Uh yes, for Jan uh no, for same [PII] for $900.
[AGENT][NEUTRAL] OK. So on this one is indicated the benefits are based on the surgical benefits and we need the surgery.
[AGENT][NEUTRAL] Plain.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So you, you received the surgery claim or not?
[AGENT][NEUTRAL] Um, let me see if we have received anything for that day.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] You guys
[AGENT][NEUTRAL] No, we have not received any additional claims for the surgery itself. So, the only one we have received is the anesthesia, but in order to determine benefits, we need the surgical charges, the surgery charges.
[CUSTOMER][NEUTRAL] OK. So the requested from the member or the provider?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It it has to be sent by us either by the provider or the member. Um, when we processed this claim, we did send out a copy of the explanation of benefits to, uh, to you, and we also send a copy to the member.
[CUSTOMER][NEUTRAL] Oh, OK. Uh, also, you send the letter to the member, right? When did you send the letter to the member?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] The same day we send the one that we sent for you, which is um the process date was [PII].
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Mhm. As of today, we have not received that.
[CUSTOMER][NEUTRAL] OK, so you didn't get any response on that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] OK, OK. Um, can you help me with the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's state.
[CUSTOMER][POSITIVE] OK. OK. Thank you, [PII]. Thank you so much, [PII], for your help and information.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] No problem. Is there anything else I can help you with today, Miss [PII]?
[CUSTOMER][POSITIVE] You too. Thank you. Bye.
[CUSTOMER][POSITIVE] Uh no, thank you. No, thank you so much.
[AGENT][POSITIVE] You're welcome. OK, thank you for calling APR. Have a good day, Ms. [PII]. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] You too. Yeah.