AccountId: 011433970860
ContactId: b8edcfd0-17d3-4f2f-aa39-09614ae2220a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 550239 ms
Total Talk Time (AGENT): 132781 ms
Total Talk Time (CUSTOMER): 101631 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/b8edcfd0-17d3-4f2f-aa39-09614ae2220a_20250115T16:02_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, and um, my name is [PII] and I'm calling um in regards to a claim that we received. Looks like they're still waiting for additional information. Can you give me a little bit more information on what is it that you're requesting from this member?
[AGENT][NEUTRAL] Sure, sure, and are you a provider or you're the insured?
[CUSTOMER][NEUTRAL] Um, provider's office.
[AGENT][NEUTRAL] OK, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you for that, and I'll be more than happy to help you with the claim. Um, [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, it is 02576102.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's um [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment, and um,
[AGENT][NEUTRAL] Let me see. Do you have either the data service or I can look it up with the claim number too?
[CUSTOMER][NEUTRAL] Um, let me see if I have it here, so.
[AGENT][NEUTRAL] Well, it looks like we only have one claim.
[CUSTOMER][NEUTRAL] Claim number is.
[CUSTOMER][NEUTRAL] Yeah, mhm.
[AGENT][NEUTRAL] This is for [PII].
[CUSTOMER][NEUTRAL] The 3
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, this is it. Hold on one second.
[AGENT][NEUTRAL] And what's the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] The name of the provider's office is uh [PII].
[AGENT][NEUTRAL] OK, this is it. I just want to make sure because this, there's no denial on this claim, both codes were paid out on.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, they are paid. OK, because I haven't, it just says something about the, your, um, on the back of this claim. It just saying that they're waiting information to confirm eligibility from be for benefits.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So I don't know.
[AGENT][NEUTRAL] You know what, I got a, I'm wondering if something's going on. I got a call with that same thing because, and so you have like one page of explanation of benefits and on the backside it gives that explanation.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, uh-huh, and it says patient responsibility is the total amount.
[AGENT][NEUTRAL] So, let me pull up the explanation of benefits on my side, and if I um if I need to fax you over a copy, I can. There may be something um going on. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And [PII], do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So I do see um two copies here, so they may have noticed the error. I can go ahead and fax you over the um correct explanation of benefits. What's a good fax number for you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, it's um [PII].
[CUSTOMER][NEUTRAL] 209.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And should I put attention, [PII]?
[CUSTOMER][NEUTRAL] Yes, and also, um, you said this claim was paid?
[AGENT][NEUTRAL] Yes, um, a total of $232.
[CUSTOMER][NEUTRAL] OK, and was this a paper check or was it a EFT?
[AGENT][NEUTRAL] Um, it was a paper check. Let me get that information for you. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it's check number 202.
[AGENT][NEUTRAL] 2711.
[AGENT][NEUTRAL] Um, it was just issued on [PII], so yesterday.
[CUSTOMER][NEUTRAL] OK, that's fine. [PII] alright.
[CUSTOMER][NEUTRAL] OK. And can I get a reference number for this call, [PII]?
[AGENT][NEUTRAL] Sure, so there's no call reference number, um, but you can use my name and today's date, and the first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right, thank you, [PII], and you're just gonna go ahead and text that right the.
[AGENT][POSITIVE] Yes, I'm faxing the explanation of benefits over to you now.
[CUSTOMER][NEUTRAL] Explanation of benefits.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that is it. Mhm.
[AGENT][POSITIVE] All right. Well, thanks for calling APLC. I hope you have a great day and happy New [PII].
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][NEUTRAL] Bye bye.