AccountId: 011433970860
ContactId: c820a32f-8cfe-4bdb-b725-8f8b0993843d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 451920 ms
Total Talk Time (AGENT): 188958 ms
Total Talk Time (CUSTOMER): 127065 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/c820a32f-8cfe-4bdb-b725-8f8b0993843d_20250318T13:11_UTC.wav
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[AGENT][POSITIVE] Good morning. 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 initial is [PII], and I'm calling the provider's office to check on a claim status. I would like to inform you that this call will be monitored and recorded for quality and training purposes. How are you today?
[AGENT][POSITIVE] I'm doing well, [PII]. How are you doing today?
[CUSTOMER][POSITIVE] I'm good, thank you so much for asking.
[AGENT][POSITIVE] That's good. Well, I'll be more than happy to help you with your claim statuses and how many clients do you have in total today?
[CUSTOMER][NEUTRAL] I have only one claim today.
[AGENT][NEUTRAL] OK, may I have the um members, well, a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it is D as in Delta 4620512.
[AGENT][NEUTRAL] OK, do you have a copy of the member's ID card available?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] On the ID card, do you see anywhere that says in hospital or outpatient policy cert number?
[CUSTOMER][NEUTRAL] I have only this, ah.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] ID number only.
[AGENT][NEUTRAL] On it's on the card, it says APL to the top left.
[CUSTOMER][NEUTRAL] It's 90 benefit multiplan employee.
[AGENT][NEUTRAL] What's the
[AGENT][NEUTRAL] OK, it's multi-plan, so that that's 90 degrees. OK, so, so you don't see anywhere that says in hospital or outpatient policy er number or start with a 01 or 02?
[CUSTOMER][NEUTRAL] 02413270.
[AGENT][NEUTRAL] OK, that's their APL policy number. Hold on one moment, I'm gonna use that.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Um, so the the member doesn't have any active policies with APL. What's the data service for your claim?
[CUSTOMER][NEUTRAL] [PII] $271 even.
[AGENT][NEUTRAL] 271. OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Is this all the same claim where's the original.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yes, it is Crestworth Physician Services LLC.
[AGENT][NEUTRAL] Alright, so I'm trying to receive the claim on [PII].
[AGENT][NEUTRAL] That claim number is 338.
[AGENT][NEUTRAL] 9461.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim a total of $50.
[AGENT][NEUTRAL] And did you need that check information?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] So let's check number 182.
[AGENT][NEUTRAL] 4634.
[AGENT][NEUTRAL] It was a single check?
[CUSTOMER][NEUTRAL] OK. And you're allowed and paid a
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Did you need the rest of the check information?
[CUSTOMER][NEUTRAL] It's $50 even, ma'am.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK. Um.
[AGENT][NEUTRAL] Let me go back to the check. Hold on one second, so we can finish the check information and then you're wanting to know the allowed amount?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so the check was a single check. Um, I don't remember if I gave you the check number, so just to be sure, it's 182.
[AGENT][NEUTRAL] 4634.
[AGENT][NEUTRAL] It was issued on [PII].
[AGENT][NEUTRAL] To Crestwood physician Services, um, [PII].
[AGENT][NEUTRAL] In [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[AGENT][NEUTRAL] And it cleared on [PII]?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome and for urgent.
[CUSTOMER][NEUTRAL] And you
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEGATIVE] You allowed and paid with $50 even only, right? With no member responsibility?
[AGENT][NEUTRAL] So we don't determine patient responsibility because we're not a major medical insurance company, but for urgent care, the benefit is up to $50 per visit with a max of 5 visits per calendar year, so that $50 was applied to this claim.
[CUSTOMER][NEUTRAL] OK, sure. Thank you very much. And let me confirm the patient account number here.
[CUSTOMER][NEUTRAL] It would be
[CUSTOMER][NEUTRAL] 745883 V as in Victor 3038.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Thank you. And could you please send me the copy of your be through mail, sorry, fax or mail?
[AGENT][NEUTRAL] What's a good fax number for you?
[CUSTOMER][NEUTRAL] Yes. The fax number is [PII] and attention to the patient account number.
[AGENT][NEUTRAL] OK, so that's [PII]. Attention to patience account number 74588 V like Victor 3038.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes, correct. Uh.
[AGENT][NEUTRAL] All right, so I'll go ahead and send this. Go ahead.
[CUSTOMER][NEUTRAL] Yeah, go ahead, go ahead.
[AGENT][POSITIVE] I'll go ahead and send this over to you now. Um, was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Uh, that's all for today, and may I know the call reference for today's call.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. Again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you so much for assisting me today. I hope you have a great day.
[AGENT][POSITIVE] Thank you, [PII]. You also, was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Uh, that's all for today. Thank you so much for that.
[AGENT][POSITIVE] Alright, you're welcome. Well thanks for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.