AccountId: 011433970860
ContactId: bbde9c83-3b4b-4880-a81f-1113163fbcad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 598109 ms
Total Talk Time (AGENT): 145918 ms
Total Talk Time (CUSTOMER): 311225 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/bbde9c83-3b4b-4880-a81f-1113163fbcad_20250422T20:26_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. And my last name is [PII]. I have called you regarding the claim status for provide me.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] So for this particular patient I have uh 3 them actually.
[AGENT][NEUTRAL] In total.
[CUSTOMER][NEUTRAL] In total I have included this one for 10 actually.
[AGENT][NEUTRAL] 4, OK. And just for my notes, can you spell your first name for me, please, and provide a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure. My full name is spelled as [PII]. The initial of my last name is [PII]. My callback number is [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you for that. And the member's policy number?
[CUSTOMER][NEUTRAL] The member's policy number is D46205536.
[AGENT][NEUTRAL] OK, do you have a copy of the member's ID card available?
[CUSTOMER][POSITIVE] Yeah, I do have it.
[AGENT][NEUTRAL] On the ID card, do you see anywhere that says in hospital or outpatient policy cert number?
[CUSTOMER][NEUTRAL] Let me see here let me check it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Mare benefit plan benefit.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold?
[CUSTOMER][POSITIVE] Sure, take your time, please. It's OK.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yeah, I'm here.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that. Wait. Were you able to locate the policy certification number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Actually this particular policy when I'm checking it here, it's saying like limited benefit medical plan VIP BSC something and there is no uh the statement you provided me. I'm not looking at this particular statement over there.
[AGENT][NEUTRAL] OK, um, may I have the member's first and last name?
[CUSTOMER][NEUTRAL] So the same, the patient first name here is mhm.
[CUSTOMER][NEUTRAL] [PII], do you want me to spell it for you?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] The first name is spelled as [PII], and the last name is spelled as [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] like.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] yeah.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I have
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] Alright, so I'm waiting for the policies to populate here.
[AGENT][NEUTRAL] Hold on one moment and you said all 4 claims are for this patient, is that correct?
[CUSTOMER][NEUTRAL] Mhm OK.
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] It's not that I
[AGENT][NEUTRAL] And this is for their medical policy?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][NEUTRAL] OK, here we go.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I'm.
[AGENT][NEUTRAL] And can you verify the member's first and last name, I'm sorry, her date of birth?
[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 may I have all the dates of service and total bills?
[CUSTOMER][NEUTRAL] So, the first set of service here is [PII]. The first time [PII].
[CUSTOMER][NEUTRAL] The total charge amount here is $3,279.60. That would be $3279.60. The second claim here, the the service is [PII].
[CUSTOMER][NEUTRAL] [PII] with the total sales amount of
[CUSTOMER][NEUTRAL] $2,489.70. That would be 24 $89.70.
[CUSTOMER][NEUTRAL] The 3rd claim here on my system.
[CUSTOMER][NEUTRAL] The service is [PII] with the total charge amount is $118 even it it is $118.
[CUSTOMER][NEUTRAL] And the fourth claim I have on the system, your service is [PII] with the total charge amount is $925 even, which is $925.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Alright, and is it alright if I place you on just a brief hold while I go through these dates of service and total bills?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Actually, I don't need to. So we don't have a claim on file for any of these dates of service.
[CUSTOMER][POSITIVE] Mhm, so take your time.
[CUSTOMER][NEUTRAL] OK, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] And can you verify the uh mailing address to which we have to make sure that claims to.
[AGENT][NEUTRAL] Yes, so the claim's mailing address is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] I'm gonna.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I can, can you provide me the pay ID as well?
[AGENT][NEUTRAL] Yes, it's 64556.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] [PII] Wonderful. Uh, for my future, can you provide me the patient policy for deinition date?
[AGENT][NEUTRAL] Mhm. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] The policy is still active and it's been effective since [PII].
[CUSTOMER][NEUTRAL] [PII] to active and for this particular patient you are the primary, right?
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] This isn't a secondary policy, so they could have other insurance, um.
[AGENT][NEUTRAL] I'm not sure. This isn't a, this isn't a secondary policy, so I don't know if they have another insurance. If not, then yes, this could be the only one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, that one. OK, I got it. Mhm, yeah, I believe. Thank you so much. And, uh, for me to verify, so can you provide the tiny part name so I can know to visit it I can submit it to them again.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Of course, so there's no timely filing limit. You can file a claim at any time as long as the policy is active on the data service.
[CUSTOMER][NEUTRAL] OK, mhm, OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][POSITIVE] Thank you so much, and [PII], I believe I have got most of the information here. And by the way, can you provide me the call reference number please because you provided me most of the same information.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Of course, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] And your first name is [PII], right?
[AGENT][NEUTRAL] Yes, [PII]
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, thank you so much and I believe you. I have, uh, I hope you have a wonderful day ahead. Thank you so much for for providing all this information. Have a wonderful day ahead, [PII].
[AGENT][POSITIVE] Thank you, [PII]. You, you also, was there anything else I can help you with today?
[CUSTOMER][POSITIVE] I believe I have got most of the information here is not on file. I believe, uh, thank you so much for providing me. Thank you so much. Take care.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] I