AccountId: 011433970860
ContactId: b8cca795-d5d7-4c31-9b82-71134a254001
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 438760 ms
Total Talk Time (AGENT): 153945 ms
Total Talk Time (CUSTOMER): 159602 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/b8cca795-d5d7-4c31-9b82-71134a254001_20250305T19:44_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, uh, this is [PII] I calling, and I am trying to, um, register an account on the website so that we can check some claim statuses, and it is coming up saying there's an error occurred during registration. Please try again. I've tried about 5 times and still get the same thing, so I was wondering if you can help me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, Miss [PII]. And when you try to register, are you putting in your patient's account number or our patient's account number?
[CUSTOMER][NEUTRAL] Um, it should be your patient account number, um, the one that says to get take it from box 26 on the, uh, claim form, and that's what I'm putting in.
[AGENT][NEUTRAL] Box 26 on the claim itself on the 1500 form?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and it's not letting you do it with that one? OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh, yeah, it is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And um may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, yeah, uh, let me see, let me go back up to that, um, their policy number is 0233437373.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient, Miss [PII]?
[CUSTOMER][NEUTRAL] Uh yeah, his first name is [PII], last name [PII], and date of birth is [PII].
[AGENT][NEUTRAL] OK, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh, this first one was, uh, data service was 218.
[CUSTOMER][NEUTRAL] And um.
[CUSTOMER][NEUTRAL] The amount was 259, uh, now this is one that was submitted to Blue Cross Blue Shield first.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And and then to um your your your organization.
[AGENT][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] All right. And you said it's [PII] of this year?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, I don't think we have that claim just yet.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, um, it's indicated as completed and um, also I know the patient himself said that he's received a notice that it's processed.
[AGENT][NEUTRAL] Which.
[CUSTOMER][NEUTRAL] Are you not showing it there?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I don't see it on their process. Let me check on their pending claims, but if it's pending, it means that it has not been processed yet, OK? Let me just go ahead and check on those and see if I have it there. Um, let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] OK, it's gonna be a minute. I have several that are pending.
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Are all the claims for the same member or different members, Miss [PII]?
[CUSTOMER][NEUTRAL] Uh, they also the same, um, we had three dates. We had 218, 221, and 225.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the 225, how much was it for?
[CUSTOMER][NEUTRAL] 225 was for um should be $323.75.
[AGENT][NEUTRAL] OK, so that one I found is in line to be processed. It was received on the [PII].
[AGENT][NEUTRAL] And it takes 7 to 10 business days for the claim to process. Um, let me get, let me pull the next one and see what day was done.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, this one is, OK, this one is the 3:18, so this one is also online. It was received the same day on the [PII].
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Let me pull this other one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, and this one is 221, part 323. Yeah, it looks like they're all in line to be processed. They were all pro uh received on the [PII].
[CUSTOMER][NEUTRAL] OK, alright so well will you not be able to um actually create the uh account until they are completed then?
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] OK, alright, so, um, and you said it generally takes how long?
[AGENT][NEUTRAL] 7 to 10 business days from the received date.
[CUSTOMER][NEUTRAL] 7 to 10 business days. OK, um, is there any notice or anything that comes to us? Um, probably not without the account, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, what do you mean?
[CUSTOMER][NEUTRAL] Like once, once you do finalize it, um, what happens from there yeah.
[AGENT][NEUTRAL] Oh, once, yeah, once we finalize, you will receive an explanation of benefits and the member will receive an explanation of benefits, either indicating we paid or either indicating the reason we did not pay. So it's just gonna be an explanation of benefits.
[CUSTOMER][POSITIVE] OK, and that I assume gets mailed to us at this time because we don't have the account set up. OK, perfect. So once I get those I know we're good to go and I can go set it up.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][POSITIVE] OK, perfect. All right, that's what I needed. I thank you very much for your help today.
[AGENT][POSITIVE] You're welcome, Miss [PII], and thank you for calling APL. Have a good afternoon.
[CUSTOMER][POSITIVE] OK thank you you too.
[AGENT][POSITIVE] You're welcome. Thank you, bye bye.
[CUSTOMER][NEUTRAL] Bye bye.