AccountId: 011433970860
ContactId: b87a676d-6e8e-4e31-85b9-9a9359278ea7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 832880 ms
Total Talk Time (AGENT): 292688 ms
Total Talk Time (CUSTOMER): 181942 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/b87a676d-6e8e-4e31-85b9-9a9359278ea7_20250206T20:16_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII] and I'm calling on behalf of Pro office. I'm looking for a claim status.
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] I'm so sorry. I didn't understand anything. Yes, I didn't understand anything you initially said though.
[CUSTOMER][NEUTRAL] Yes, hello.
[CUSTOMER][NEUTRAL] Yes, my name is [PII] and I'm calling on behalf of provider office and looking for status. First of all, may I know your name? What's your name?
[AGENT][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Again, my name is [PII].
[CUSTOMER][NEUTRAL] [PII], correct?
[AGENT][NEUTRAL] No, no. [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] You're welcome. And what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And you're needing claim status, is that correct?
[CUSTOMER][POSITIVE] Uh, that is correct.
[AGENT][NEUTRAL] OK. I can help you with that. How many claims do you have, [PII]?
[CUSTOMER][NEUTRAL] I have 3 claims only.
[AGENT][NEUTRAL] Are these 3 claims for 3 different patients or the same patient with multiple dates of service?
[CUSTOMER][NEUTRAL] Uh yeah.
[CUSTOMER][NEUTRAL] Three different patients.
[AGENT][NEUTRAL] And one data service each, is that correct?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, so [PII], uh, a couple of things up front, you will use my name that I gave you along with today's date as your call reference number for each. Also, you're, you're welcome. Any information that I provide for you on any claim that I check will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][POSITIVE] Thank you, thank you.
[AGENT][NEUTRAL] And lastly, if we do have the claims on file and you need a copy of any of the explanation of benefits, you can go to our portal and print them yourself.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And our portal website John is secured.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Again, that is secured. [PII]. And what is your first patient's policy number?
[CUSTOMER][NEUTRAL] Policy number is, let me check.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] 02344570 ML 7.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And what is your patient's name and date of birth for this policy?
[CUSTOMER][NEUTRAL] Uh, patient name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you. The data service and total bill amount.
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total bill amount is $1,709.17.
[AGENT][NEUTRAL] And you said 11:23, is that correct?
[CUSTOMER][NEUTRAL] That is correct. [PII]:23, 2024.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] OK, so [PII], you have an incorrect policy number?
[AGENT][NEUTRAL] The correct policy number that you should have for this number because the policy number you gave me terminated 10-1-2024 which was prior to your data service.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. And the new updated, uh, may I know the new updated policy number?
[AGENT][NEUTRAL] The correct policy number is 02544986.
[AGENT][NEUTRAL] That policy was active from 10-1-2024 to its term date of [PII]. Give me just a moment to see if the claim was received.
[CUSTOMER][NEUTRAL] Um, I'll see what.
[AGENT][NEUTRAL] OK, so this claim was received on 12-26-2024. It was processed and denied on 12-30-2024. The claim number.
[AGENT][NEUTRAL] It's 354-562-7.
[CUSTOMER][NEUTRAL] Wait a moment. Uh, could you please, uh, 34.
[AGENT][NEUTRAL] You do you need for me to repeat the claim number?
[CUSTOMER][POSITIVE] Yes, that, yes, that is correct.
[AGENT][NEUTRAL] 354 562-7.
[CUSTOMER][NEUTRAL] 563-27. Correct?
[AGENT][NEUTRAL] 354.
[AGENT][NEUTRAL] 562 7.
[CUSTOMER][POSITIVE] OK. Thank you, [PII].
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And this claim was denied and the reason for the denial is that we need the primary insurance company's explanation and benefits.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, let's move for another claim.
[AGENT][NEUTRAL] OK, and you're gonna have to give me just a moment to make my notes on this policy before we can move to the next one.
[CUSTOMER][POSITIVE] Take your time, take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Give me just one moment please, [PII].
[AGENT][NEUTRAL] OK, and what is your next patient's policy number?
[CUSTOMER][NEUTRAL] Uh, policy number 02509836.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] And the member's name is [PII] [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] They took
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And the date of service is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Total charge amount is $1,396.01.
[AGENT][POSITIVE] OK, one moment, thank you.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so, and again you said data services [PII], is that correct?
[CUSTOMER][NEUTRAL] Uh, you mean, you mean date of service? Yes, yes.
[AGENT][NEUTRAL] Is that, is that correct, [PII]?
[AGENT][NEUTRAL] The data service [PII].
[CUSTOMER][NEUTRAL] Yes, yes. Yes, yes. [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so this claim was received.
[AGENT][NEUTRAL] The received date on this claim was [PII], I'm sorry, that's not correct. Just one moment.
[AGENT][NEUTRAL] OK, so this claim was received on [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[AGENT][NEUTRAL] The claim number?
[AGENT][NEUTRAL] It's going to be
[AGENT][NEUTRAL] 354-7[PII].
[AGENT][NEGATIVE] And this claim was also denied because we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And let's move for on the claim.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, and the next patient's policy number?
[CUSTOMER][NEUTRAL] 02509927 ML 7.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Member's name.
[AGENT][NEGATIVE] No, I'm not ready. No, no, not yet.
[CUSTOMER][NEUTRAL] Member's name is [PII], uh.
[AGENT][NEUTRAL] It's still loading, no, just a moment, [PII], just a moment. The member's information hasn't loaded.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and your patient's name and date of birth?
[CUSTOMER][NEUTRAL] A patient name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[CUSTOMER][NEUTRAL] Date of service.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Date of service, [PII]. Bill amount is $569.09.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 569.09. Is that correct?
[CUSTOMER][NEUTRAL] Yes, 569.09, correct.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] This claim was also received. One moment. Are you gonna, do you need the receive date and the process date or just the claim number and the status?
[CUSTOMER][POSITIVE] Yes, yes. Correct.
[AGENT][NEUTRAL] Only the claim number and status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so the claim was received. The claim number is 3546958 and this claim was also denied because we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] And where was the receipt?
[AGENT][NEUTRAL] [PII], processed and denied on [PII].
[CUSTOMER][POSITIVE] Thank you. Thank you, [PII]. Have a nice day. Bye-bye.
[AGENT][POSITIVE] You're very welcome. Absolutely, you're very welcome. Can I help you with anything else today?
[CUSTOMER][POSITIVE] No, nothing weird. Thank you so much again. Bye-bye. Have a nice day. Bye-bye.
[AGENT][POSITIVE] OK. Well, you're welcome. Yes, sir. I hope you do too, and thank you again for calling APL [PII].