AccountId: 011433970860
ContactId: c7cd545d-449f-4ddb-b7c2-f4d6aaf4c86b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 477149 ms
Total Talk Time (AGENT): 119047 ms
Total Talk Time (CUSTOMER): 165633 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/c7cd545d-449f-4ddb-b7c2-f4d6aaf4c86b_20250402T18:52_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEGATIVE] Sorry to say but uh your voice is like so disturbing. It's not clear.
[AGENT][NEUTRAL] OK, can you hear me better?
[CUSTOMER][NEUTRAL] OK, yeah. Uh, myself, [PII]. I'm calling from Skin and Cancer Associates provider's office. So how are you doing today?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][POSITIVE] I'm doing good. Thank you for asking. May I know your name, please?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi, [PII]. Uh, yeah, before I proceed, please be informed that these calls are being recorded for quality and training purposes. Are you OK with this?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Thank you. Actually, I do have some claims which uh like the primary have paid and we have billed uh to American public life and we do not have any response for that.
[AGENT][NEUTRAL] Ex
[CUSTOMER][NEUTRAL] So further, we have faxed, like we have faxed the primary UB and the secondary claim form.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Uh, do you have a good callback number, [PII]?
[CUSTOMER][NEUTRAL] Yeah, that would be [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number of the patient you're wanting to check on, claim status?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, I do have it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's um wait a minute.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] Date of birth would be [PII].
[AGENT][NEUTRAL] OK, that policy number you gave me pulled up a totally different person. Do you, let me try that policy number again. Could you repeat that?
[CUSTOMER][NEUTRAL] Yeah, it's uh 60801. It is showing me that only.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And that says the policy number or is that like the group number?
[CUSTOMER][NEUTRAL] It's the policy number.
[AGENT][NEUTRAL] OK, um, that's not what I have.
[CUSTOMER][NEUTRAL] I do, I do have the group number.
[AGENT][NEUTRAL] OK, what is that?
[CUSTOMER][NEUTRAL] I do have the group number. Could I help you?
[CUSTOMER][NEUTRAL] Yeah, that is 80059.
[AGENT][NEUTRAL] And what was the patient name?
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[AGENT][NEUTRAL] OK, I'm not pulling that up either. Let me look it up by name. Do you have a social security number by chance?
[CUSTOMER][POSITIVE] Secure, yeah, I do have it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That would be [PII].
[AGENT][NEUTRAL] OK, I located the number. Let me pull it up real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what was that date of service?
[CUSTOMER][NEUTRAL] Detail service is um [PII], sorry, [PII].
[AGENT][NEUTRAL] And the charges?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It charges? How much was charged?
[CUSTOMER][NEUTRAL] Yeah, it's
[CUSTOMER][NEUTRAL] $277 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, this claim was denied. Office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK. Uh, do you have the claim number?
[AGENT][NEUTRAL] Claim number is 356.
[AGENT][NEUTRAL] 3866.
[CUSTOMER][NEUTRAL] 3563866
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Uh, so, uh, could you fax us the EOB?
[AGENT][NEUTRAL] Yes, what's your fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, did you have another claims?
[CUSTOMER][NEUTRAL] [PII], could you help me?
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yeah, I do have like a few more claims like 10 to 12 claims, but could you help me with this, uh, the member ID for this patient? What is the current member ID for this patient?
[AGENT][NEUTRAL] Member ID is 2,486,800.
[CUSTOMER][NEUTRAL] 248-6800.
[AGENT][NEUTRAL] Did you say you had 12 claims?
[CUSTOMER][NEUTRAL] Yeah, I do have like 12 to 13 claims, I think.
[AGENT][NEUTRAL] OK, do you have access to our
[CUSTOMER][NEUTRAL] So, that's it.
[AGENT][NEUTRAL] Portal
[CUSTOMER][NEUTRAL] Uh, no, I think we do not have the access.
[AGENT][NEUTRAL] To the secured. [PII] that's where you can pull EOBs.
[CUSTOMER][NEUTRAL] Like is it
[CUSTOMER][NEUTRAL] OK. Is it uh the self-registration one?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Could you help me with the site and like what's the
[AGENT][NEUTRAL] The site is secured. It's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We will be able to pull the status in this, right?
[AGENT][NEUTRAL] Yes, and you'll be able to pull the explanation of benefits.
[CUSTOMER][POSITIVE] OK. Uh, yeah. Thank you so much uh for this information, [PII]. Could you help me with the call reference number for this?
[AGENT][NEUTRAL] Oh, it'd be my first name, [PII], first initial to my last name is [PII], and today's date.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, uh, and, uh, can I know the the turnaround time for the requested UV?
[AGENT][NEUTRAL] Um, once we get off the call, I'm gonna fax it to you, so just give me about 5 minutes.
[CUSTOMER][POSITIVE] OK, sure. Thank you. Thank you so much, [PII]. Have a great day.
[AGENT][POSITIVE] OK, thank you for calling [PII]. Have a good day.