AccountId: 011433970860
ContactId: bf13111a-b6d2-4532-abb0-98a144bdebfe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 448130 ms
Total Talk Time (AGENT): 203221 ms
Total Talk Time (CUSTOMER): 109012 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/bf13111a-b6d2-4532-abb0-98a144bdebfe_20250114T19:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. Could you please help me with the claim?
[AGENT][NEUTRAL] Yes, what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. What is the policy number, please?
[CUSTOMER][NEUTRAL] Policy ID is 01942505 M as in Mary, L as in Lima, B as in Bravo.
[AGENT][NEUTRAL] OK, that's more than likely the number 8. Let me just repeat that to you. I have that as 01942505 ML 8.
[AGENT][NEUTRAL] Verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] OK, just uh member's name [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And again, I can assist you with claim status. What is the date of service? Thank you. Can I build them out, please.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Date of service is [PII]. And the bill amount, it is $3,743.
[AGENT][NEUTRAL] OK, let me just repeat that to you, [PII]. I have that as [PII]. Total charges are $3,753 even.
[CUSTOMER][NEUTRAL] No, no, 3007.43.
[AGENT][NEUTRAL] 3007.43, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. Now with this particular policy number that was provided, it turned as of [PII].
[AGENT][NEUTRAL] I do not show this claim on file. Let me check to see if there is a policy with that date range. One moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] OK, thank you very much for your patience. I was able to locate an active policy. I can provide that policy number to you when you are ready.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, it is 02250224 ML 8.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and this policy shows effective as of [PII] and it shows active. Now bear with me, let me check for that date of service and build amount please.
[AGENT][NEUTRAL] OK, I show that we received a claim and we are requesting the explanation of benefits from the primary insurance provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is the claim number?
[AGENT][NEUTRAL] A claim number shows 3,532,510.
[CUSTOMER][NEUTRAL] OK. And, uh, so, uh, can we res uh so we have to resubmit this one or uh we have to send only explanation of benefits from private.
[AGENT][NEUTRAL] Only the explanation of benefits from the primary is requested.
[CUSTOMER][NEUTRAL] OK, uh, and could you please verify the mailing address or any fax so that we can easily send it to.
[AGENT][NEUTRAL] Oh, certainly, of course. Our fax number is [PII].
[AGENT][NEUTRAL] And our mailing address?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Would you like the mailing address as well?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, it is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] City, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] You're welcome. Is there anything else I can assist you with, [PII]?
[CUSTOMER][NEUTRAL] Uh, I have one more claim. Is it possible to help me with that one?
[AGENT][NEUTRAL] Is it for the same member or a different member?
[CUSTOMER][NEUTRAL] No, it's a different number.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, what is that policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Right um policy ID is
[CUSTOMER][NEUTRAL] 02462030.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lima, 8.
[AGENT][POSITIVE] OK, thank you very much. One moment.
[AGENT][NEUTRAL] And also, [PII], you're able to check claim status by visiting our secure portal at [PII].
[AGENT][NEUTRAL] And bear with me, let me pull up the 2nd policy number.
[AGENT][NEUTRAL] OK. And if you would verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Member's name, [PII]. Date of birth [PII].
[AGENT][POSITIVE] Thank you very much for that information. If you could also provide that date of service and the total charge amount please.
[CUSTOMER][NEUTRAL] Date of service is [PII].
[CUSTOMER][NEUTRAL] And the total charge amount, it is for $2,317.98.
[AGENT][POSITIVE] OK, thank you very much. One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Thank you. It shows that the claim was received. We are requesting the explanation of benefits from the primary insurance provider and only the explanation of benefits is requested. I have that claim number for you when you're ready.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK. It is 351-917-9.
[CUSTOMER][NEUTRAL] OK. And uh when it was received?
[AGENT][NEUTRAL] OK. It was received on [PII] and processed on the same date, [PII].
[CUSTOMER][NEUTRAL] OK, thank you. What's the license number?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] We do not provide reference numbers. [PII], however, you can use my name. My last initial is [PII], first name is [PII], and today's date.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][POSITIVE] You're welcome, [PII], and thank you for calling APL. Have a good day. Mm bye.