AccountId: 011433970860
ContactId: c35e542e-8b5d-4c88-857f-0d9b337b5974
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 376609 ms
Total Talk Time (AGENT): 195422 ms
Total Talk Time (CUSTOMER): 148555 ms
Interruptions: 5
Overall Sentiment: AGENT=0.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/c35e542e-8b5d-4c88-857f-0d9b337b5974_20250311T18:02_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling from James River Dermatology, and I was calling to check claim status for one of our patients.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I see you're needing to check claim status for one member, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Yes, ma'am, I can help you with that. And what is your callback number please, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] It's 01832184.
[AGENT][NEUTRAL] OK, thank you. One moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] On I see any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and your date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, the name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her place?
[CUSTOMER][NEUTRAL] OK, day service [PII] and the total charge was $237.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and again, you said it's for [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, now we do not have a claim on file for her for that data service.
[CUSTOMER][NEUTRAL] OK, that makes sense right now I will get that sent out to you guys and just to double check with you oh go ahead.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Let me just make sure, I wanna look at one thing we've got.
[AGENT][NEUTRAL] We've received a claim that's not, I mean, it's just been received and it's not been reviewed. I.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you know for sure that you all did or?
[AGENT][NEUTRAL] Did submit it.
[CUSTOMER][NEUTRAL] We, uh, we think, I mean from what we can tell, let me, we think, um, let me check the billing logs to make sure, um, yes ma'am, it went paper.
[AGENT][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] I can just look at this information. OK, so give me.
[CUSTOMER][NEUTRAL] It went on a paper hick.
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] And this may be it that we just literally received yesterday.
[CUSTOMER][NEUTRAL] And that would make sense for the for the postal service since it went US postal service.
[AGENT][NEUTRAL] So let me look at the bill amount and just see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And we're good just as long as you guys got it we're good and we can wait for processing.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK. So you said the bill, and who is the provider?
[CUSTOMER][NEUTRAL] Provider is [PII].
[CUSTOMER][NEUTRAL] F A R R
[CUSTOMER][NEUTRAL] Um, for James River Dermatology.
[AGENT][NEUTRAL] OK, so, um, can, maybe I misheard the billed amount.
[CUSTOMER][NEUTRAL] 2:37.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] I could have said the wrong amount to be honest with you.
[AGENT][NEUTRAL] No, um, and I, and the reason that I'm just trying to clarify that is this claim that we did receive.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, wait just a second. No, we have not received a claim for that data service.
[CUSTOMER][POSITIVE] OK, OK, then I will just send another one out to be sure um but that that's definitely all I needed to know but thank you so much, [PII] you have a good afternoon. mhm.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And yes, ma'am, and you're welcome, [PII], but let me tell you just a couple more things before you go. So when you do submit the claim to APL, please include the a copy of our primary insurance company's explanation of benefits because we do have to have that. And then are you familiar with our portal that you can also check claim status in once we've processed the claim? OK, so we have a portal.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh no, oh OK.
[AGENT][NEUTRAL] Uh huh, that you should be able to check claim status in and that portal website is secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Alright, that's secured. [PII].
[AGENT][POSITIVE] That is correct, yes ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] Got it. OK, and if I could, can I just verify we're sending it to the right address? Um, we have [PII]. No, OK, problem, right.
[AGENT][POSITIVE] Absolutely, uh-huh.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] That's an old one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] That could be the big problem.
[AGENT][NEUTRAL] Oh, yes.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] Uh, yeah.
[AGENT][NEUTRAL] OK, so, um, I'm so sorry, the correct claims PO box that you should have.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is going to be [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it, [PII].
[CUSTOMER][POSITIVE] Perfect. Alright, I'll get that updated as well.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Uh we're just sending stuff all over the place. OK, well thank you so much, [PII]. Thank you and also I'll check the portal.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, it happens. Well, you're certainly welcome. Yes, ma'am. OK. And if you are not able to locate the claim in the portal, then obviously always give us a call and we'll be more than happy to help you.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] OK, well, you're welcome, [PII]. So again, if that is all I can help you with, thank you for calling APL and I hope you have a wonderful afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye-bye.