AccountId: 011433970860
ContactId: b9aa92a8-376c-4915-9640-107b661152ae
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 372049 ms
Total Talk Time (AGENT): 133047 ms
Total Talk Time (CUSTOMER): 189629 ms
Interruptions: 3
Overall Sentiment: AGENT=2.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/b9aa92a8-376c-4915-9640-107b661152ae_20250212T22:08_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[AGENT][POSITIVE] Good afternoon. Thank you for calling.
[CUSTOMER][POSITIVE] Yes, good afternoon.
[CUSTOMER][NEUTRAL] Yes, good afternoon, [PII]. This is [PII]. I'm calling you from the provider office. How are you doing today?
[AGENT][POSITIVE] I'm doing well, [PII], how are you?
[CUSTOMER][POSITIVE] Yes, I'm doing great, thanks for asking me. OK, so I have the general claim status like the question regarding the claim. So could you please help me with that?
[AGENT][POSITIVE] Yes, I'll be more than happy to help you with the claim status. May I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure. The callback number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] OK, the member's policy number is going to be 02274045.
[AGENT][NEUTRAL] 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] Sure, the member's first name is [PII]. It's it's [PII] and the date of birth is going to be [PII].
[CUSTOMER][NEUTRAL] Like [PII].
[AGENT][POSITIVE] Thank you for that and all the
[AGENT][NEUTRAL] All right, and all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service or the claim number for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] Mhm. Right.
[CUSTOMER][NEUTRAL] Sure. The date of service is going to be [PII] and the charge amount is $895.06.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you for that. And again, just for the call, the information provided is a verification of benefits, not a guarantee of payment. And so hold on one moment.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] So actually shown that no claims have been processed um yet for [PII]. We haven't processed any claims for him yet.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. OK. No, no, uh, I just, uh, talked with your one of your representatives. Her name is [PII], and she told me the claim paid amount is $75 and the rest of the amount is the patient's policy like the responsibility. So I just wanna, I'm just giving a call.
[AGENT][NEUTRAL] OK, hold on one second. Hold on 1 2nd, hold on 1 2nd. The policy number that you gave me is for the dental policy. Are you looking for another type of policy, the medical policy?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's, yes, yes, the medical.
[AGENT][NEUTRAL] OK, because that pulled up dental, so hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So the medical policy number is 2274042.
[CUSTOMER][NEUTRAL] Uh, it's 227-4045.
[AGENT][NEUTRAL] OK, so what I'm letting you know is the policy number that ends in 045 is a dental policy. That's why I was not able to find a claim. The policy number that I just gave you that ends in 4042 is their hospital indemnity medical policy. So I'm going to pull that claim, that policy up now to find the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, OK. Mhm.
[CUSTOMER][POSITIVE] OK, [PII]. Take your time.
[AGENT][NEUTRAL] And what is the question that you have for the claim?
[CUSTOMER][NEUTRAL] Uh, I have the question that she told me that the claim paid amount, uh, is $75 and the rest of the amount is, she was telling me that the, the patient responsibility or they send, it's up to the provider, something like that. So I just wanna make sure, I just wanna know that could you guys please send me the EOB on my fax number so I can, so we can see that, that which CPT is paid, which CPT is denied, like the explanation of benefits.
[AGENT][NEUTRAL] OK, yes. What's the, yes, I understand. What's the date of service you said [PII]?
[CUSTOMER][NEUTRAL] So, yeah.
[CUSTOMER][NEUTRAL] No, the [PII].
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what's a good fax number to send the explanation of benefits to?
[CUSTOMER][NEUTRAL] OK, let me tell you the number. The number is [PII].
[AGENT][NEUTRAL] And should I put attention, [PII]?
[CUSTOMER][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] All right, I'm faxing this over to you now. [PII], was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Uh, no, let me just, uh, have you sent it?
[AGENT][NEUTRAL] Yes, but it's by fax. So usually you get fax about an hour. Um, if you don't receive it by the end of day today, we close at [PII] central time. Just let us know and we'll be more than happy to resend it for you, but yes, I have sent it to you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, OK, [PII], thank you so much for letting me know. And, and you are asking like, no, I don't have any other question. And so,
[CUSTOMER][NEUTRAL] Yes, I have one question. So where are you from? Are you working from like the from home or from the office?
[AGENT][NEUTRAL] I'm in office.
[CUSTOMER][POSITIVE] OK, OK, OK. OK. So, OK, [PII], thank you so much. It was very helpful for me and it was lovely to talking with you. You're a very nice lady to me. So thank you so much. That's all I wanted to know. And if there, if I need any kind of assistance, I will give you, you guys call again, OK?
[AGENT][POSITIVE] Alrighty, well, thank you so much for calling [PII], and I hope you have a great day.
[CUSTOMER][NEUTRAL] You too, [PII]. bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.