AccountId: 011433970860
ContactId: cde378ab-a59b-4d28-894e-48f28b614f21
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 809039 ms
Total Talk Time (AGENT): 217233 ms
Total Talk Time (CUSTOMER): 490283 ms
Interruptions: 17
Overall Sentiment: AGENT=1.2, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/cde378ab-a59b-4d28-894e-48f28b614f21_20250129T20:17_UTC.wav
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[AGENT][POSITIVE] Good afternoon.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Thank you for calling APL. This is Tr[PII]How can I help you?
[CUSTOMER][NEUTRAL] Good afternoon. Yes, Miss Ra[PII]My name is Ri[PII].
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes, Tr[PII]My name is Ri[PII]alling from doctor's office inquiring on the status of a claim.
[AGENT][NEUTRAL] Hey, you said your name is Ri[PII]Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and you're needing claim status for one claim, is that also correct?
[CUSTOMER][NEUTRAL] Yeah, I have 2 claims.
[AGENT][NEUTRAL] OK, so the two claims that you have, Ri[PII]are they for the same member or different patients?
[CUSTOMER][NEUTRAL] A number or different patients. Uh, one moment, I checked that another patient.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It's a different patient.
[AGENT][NEUTRAL] OK, so yes, I can help you and what is your callback number please?
[CUSTOMER][NEUTRAL] OK, yes I can help you. What is your callback number please? Yes, my direct telephone number is 44[PII].
[AGENT][NEUTRAL] Thank you and Ri[PII]you will use my name that I gave you along with today's date as your call reference number for each one. Also, any information that I provide for you on either claim will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] She reference number for each one that I provide you your claim will be a verification of benefits and not a guarantee.
[AGENT][NEUTRAL] And then if you need a copy.
[CUSTOMER][NEUTRAL] What's the last edition?
[AGENT][NEUTRAL] S and yours?
[CUSTOMER][NEUTRAL] F. R like Romeo.
[AGENT][NEUTRAL] Thank you, and if you need, if we do have the claims on file and you need a copy of either explanation and benefits, you may print them from our portal by going to se[PII].
[CUSTOMER][NEUTRAL] explanation I print them from our portal by do[PII]OK.
[AGENT][NEUTRAL] Alright, and what is the first patient's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, the policy ID number is 025.
[CUSTOMER][NEUTRAL] 21747.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] One moment please.
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] But me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] I'm not gonna.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] OK, and what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] His first name is uh Gy[PII].
[CUSTOMER][NEUTRAL] But it is uh No[PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount please for her?
[CUSTOMER][NEUTRAL] Yeah, service date is Oc[PII]The amount is $267 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] You said $267 is that correct?
[CUSTOMER][POSITIVE] Uh yes, you're right. 267.
[AGENT][NEUTRAL] OK, so we do not have a claim on file for that data service for her for that bill amount.
[CUSTOMER][NEUTRAL] Not have a client file for that service um for that amount. Mhm. Was this patient policy active for the service state?
[AGENT][NEUTRAL] It was, this policy was active.
[CUSTOMER][NEUTRAL] 81 of 24.
[AGENT][NEUTRAL] Effective 8-[PII].
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Are the primary insurance.
[AGENT][NEUTRAL] And it is still active?
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] Pardon me? Are you the primary insurance?
[AGENT][NEUTRAL] I didn't understand your question. No, we are the secondary. I was just about to explain to you, when you submit the claim to APL you will also need to send us a copy of her primary insurance company's explanation of benefits for review.
[CUSTOMER][NEUTRAL] OK, uh, I have your claim mailing address as PO[PII].
[CUSTOMER][NEUTRAL] Ok[PII]Yeah.
[AGENT][NEUTRAL] That is correct. 89[PII].
[AGENT][NEUTRAL] And I'm very sorry, but Ri[PII]there's some background noise where you're located that's making it extremely difficult for me to hear you.
[CUSTOMER][NEUTRAL] My
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Uh, is your pay, uh, pay ID is 68[PII]?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, uh, as for your record, can I know who is the primary insurance?
[AGENT][NEUTRAL] I don't have detailed information on the Premier. I can tell you who we showed for her husband's employer, but you would have to contact the member to get the information for her primary insurance. We do not have that.
[AGENT][NEUTRAL] The primary insurance company for his employer appears to be S C P E B A.
[CUSTOMER][NEUTRAL] Primary employer S S C P B A.
[AGENT][NEUTRAL] Mhm. I don't know what, yes, it says P E B as in Bravo, A.
[CUSTOMER][NEUTRAL] OK, uh, mhm.
[CUSTOMER][NEUTRAL] Uh, crazy, um.
[CUSTOMER][NEUTRAL] There's there is no time frame to submit the claim, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] 2595. Yeah.
[CUSTOMER][NEUTRAL] Primary EOB.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I'll go with the next patient when you are.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] actually.
[CUSTOMER][NEUTRAL] You see what I got.
[CUSTOMER][NEUTRAL] How.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Uh, the other.
[AGENT][NEUTRAL] OK, and the next patient's policy number?
[CUSTOMER][NEUTRAL] Can I get your policy number. Yes, uh, the next policy it is 01813684.
[AGENT][NEUTRAL] Did you say 3684?
[CUSTOMER][NEUTRAL] 368 4. Yeah.
[CUSTOMER][NEUTRAL] So.
[AGENT][POSITIVE] Thank you. Alright, one moment.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] OK, and any information on this one also that I provide for verification of benefits and not a guarantee of payment. So Ri[PII]what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, patient name is Sh[PII]ust.
[CUSTOMER][NEUTRAL] Birthday, birthday is No[PII].
[AGENT][NEUTRAL] I'm sorry, what was the date of birth again?
[CUSTOMER][NEUTRAL] I'm sorry, what was the date of birth again? It's No[PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I keep.
[AGENT][NEUTRAL] And the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Yeah, data services Oc[PII].
[CUSTOMER][NEUTRAL] Bill amount on this claim is.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] $313 even.
[AGENT][NEUTRAL] 313
[CUSTOMER][NEUTRAL] 313 Yeah.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, just a moment for me to pull up some additional information.
[CUSTOMER][NEUTRAL] information. OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEGATIVE] You have the call uh you not for direction.
[CUSTOMER][NEUTRAL] Get.
[CUSTOMER][NEUTRAL] Just.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] She
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Hello Al[PII]Oh hello Al[PII].
[CUSTOMER][NEGATIVE] Is afraid to do that.
[CUSTOMER][NEUTRAL] Oh, I'm just uh.
[AGENT][NEUTRAL] OK, so we also do not have a claim on file for this number for that data service, Richie.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is the policy date for this number?
[AGENT][NEUTRAL] Policy effective date is going to be just one moment and I'll provide that.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Secondary.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 12[PII]nd it is active.
[CUSTOMER][NEUTRAL] From 1 [PII]nd it is active? Are they acting as a primary or secondary for this one?
[AGENT][NEUTRAL] This is a limited benefit. This is a hospital indemnity limited benefit plan.
[CUSTOMER][NEGATIVE] This is a limited benefit. This is a limited benefit plan.
[AGENT][NEUTRAL] That this member has with us. We are not a major medical insurance, and again, you would have to contact the insured to find out if there's any other insurance for her.
[CUSTOMER][NEUTRAL] This number has with us we are not a medical insurance and again you would have to contact.
[CUSTOMER][NEUTRAL] The insured to find out if there's any other insurance for her.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] It is that's all the information you're looking for today thank nice day bye now. OK that's all. You also bye now thank you thank you bye bye bye bye.
[AGENT][POSITIVE] OK, well, thank you for calling APL if that's all I can help you with, and I hope you have a nice evening as well.
[AGENT][POSITIVE] Thank you. Bye bye. Uh-huh.