AccountId: 011433970860
ContactId: c953449f-0be0-4c63-b067-d305b5c31f83
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 717250 ms
Total Talk Time (AGENT): 214704 ms
Total Talk Time (CUSTOMER): 213337 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/c953449f-0be0-4c63-b067-d305b5c31f83_20250613T16:11_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling AP is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning. My name is [PII] First initial of my last name [PII]. I'm calling because I want to review three claims for the same patient.
[AGENT][NEUTRAL] OK, so you're calling for claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I can assist with that, [PII]. What is your callback number?
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][POSITIVE] Thank you so much, [PII]. What is that policy number?
[CUSTOMER][NEUTRAL] It is a second.
[CUSTOMER][NEUTRAL] 02573500.
[AGENT][NEUTRAL] OK, let me just repeat that to confirm. I have that as 02573500.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you, verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you very much. And again, your comfort claim status I can assist you. Um, when is that date of service and the total charge amount, please?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes, for the first one that I would like to review is for [PII], uh, bill amount $325.
[AGENT][POSITIVE] OK, thank you very much. Give me one moment please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] If you could verify the procedure code bill for the service for the member please.
[CUSTOMER][NEUTRAL] It's supposed to be 99204.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you so much. It shows that the claim was received and it shows denied as office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Office in October and one was received.
[AGENT][NEUTRAL] OK, one moment, please.
[AGENT][NEUTRAL] Received on [PII] and it was processed on [PII].
[CUSTOMER][NEUTRAL] [PII] processed and.
[CUSTOMER][NEUTRAL] Since it's not covered, the remaining balance is patient responsibility, right?
[AGENT][NEUTRAL] APL doesn't determine patient's responsibility.
[CUSTOMER][NEUTRAL] OK, sorry, could you repeat it?
[AGENT][NEUTRAL] APL does not determine patients responsibility.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] APL doesn't
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I would like to review another two claims for the same patient. The date was.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and the total charges?
[CUSTOMER][NEUTRAL] $385 even.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] 9
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, that also denied as office visits are not covered by the policy. Give me one second to get those claim details for you.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, the claim was received. Give me one second.
[AGENT][NEUTRAL] Thank you. On [PII] and denied on [PII].
[CUSTOMER][NEUTRAL] [PII]. Thank you. The last one that I would like to review was on [PII].
[AGENT][NEUTRAL] OK, and the total charge is billed.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] $180.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, shows that the claim was received on [PII] and processed and denied on [PII].
[CUSTOMER][POSITIVE] Wow
[AGENT][NEUTRAL] As office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] that has some cover.
[CUSTOMER][NEUTRAL] Good, um, that's all the claims that I would like to review. Um, may I please have the reference number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We do not provide reference numbers. However, you can use my name [PII] last initial [PII], and also [PII], you're able to review claim status on our secure website at [PII]. Now, would you need those claim numbers?
[CUSTOMER][NEUTRAL] Your
[CUSTOMER][NEUTRAL] So I have
[CUSTOMER][NEGATIVE] I would really appreciate that uh after this I before I call I tried like 3 times to get enrolled into that secure portal. However, when I put the uh tax ID that is placed on the claim and basically is not allowing me to go ahead and continue the enrollment. I don't know if you have any advice or tip.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, would you like to try while we're on the phone?
[AGENT][NEUTRAL] I can provide you the claim numbers, that would be easier as well.
[CUSTOMER][NEUTRAL] Um, yeah.
[CUSTOMER][NEUTRAL] Yeah, I already have the website open. Uh, the first step I have to put myself up as provider, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm gonna put the tax ID for all the claims that are the same [PII].
[CUSTOMER][NEGATIVE] It's giving me an error like no user was found with the information that was entered and request me to call customer service.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What I will do.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and you said that tax ID number is [PII], correct? OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it's the one that I put.
[AGENT][NEUTRAL] OK and this is for a provider.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Let
[AGENT][NEUTRAL] OK, let me place you on a brief hold please, [PII] one moment thank you.
[CUSTOMER][POSITIVE] Sure, sure, thank you.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] My apologies, [PII], I was trying to access the help guide to help you along the way, so I apologize for that.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Help. OK, um, my apologies.
[CUSTOMER][NEUTRAL] Yea[PII]
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so and you received an error message.
[CUSTOMER][NEUTRAL] Sure no no
[AGENT][NEUTRAL] Um, and I'm just waiting for this to populate.
[CUSTOMER][NEUTRAL] It's just two letters right.
[CUSTOMER][NEUTRAL] Hm
[AGENT][POSITIVE] OK, what I can do for you, I do apologize, [PII], I can just go ahead and fax over these ELBs for you.
[AGENT][NEUTRAL] I apologize for the delay.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It's OK, no worries. So basically at the moment uh it's not possible to get enrolled, right?
[AGENT][NEUTRAL] Uh, I was trying to assist you in the enrollment process. Um, I was actually looking for a help guide that I can possibly even email over to you or fax over to you. I'm not able to find that and again I apologize for that, but I can go ahead and fax those excuse me, fax those ELBs to you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Good, good. I really appreciate that. Um, well, the fax number is [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, let me just repeat that to you to confirm. I have that as 7702461248.
[CUSTOMER][POSITIVE] It is yes.
[AGENT][NEUTRAL] OK, and should I put attention [PII]?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, alright, I'll get those faxed over to you and please allow a few minutes after the call before you receive those, um, EOBs. Uh, anything else I can assist you with, please?
[CUSTOMER][POSITIVE] Um, that's all for today. Thank you so much for all the assistance.
[AGENT][POSITIVE] You're very welcome and thank you for calling APL. Take care.
[CUSTOMER][NEUTRAL] You too goodbye.
[AGENT][NEUTRAL] Bye.