AccountId: 011433970860
ContactId: cf91092b-957f-4f05-83a5-e6e6f17bcb4f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 390630 ms
Total Talk Time (AGENT): 139469 ms
Total Talk Time (CUSTOMER): 182642 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/cf91092b-957f-4f05-83a5-e6e6f17bcb4f_20250220T17:16_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Hey, [PII]. Uh, my name is [PII] calling from a provider and I just need to, um, I have a question about a claim. Can you help me with that?
[AGENT][NEUTRAL] I can, [PII], do you mind holding just one moment? I'm waiting for my system to come back up. I apologize.
[CUSTOMER][NEGATIVE] Not at all.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I do apologize, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's coming up. Let's see, bear with me just one second. Do you have a claim number, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, let me see, I should.
[CUSTOMER][NEUTRAL] Account number, let me look.
[CUSTOMER][NEUTRAL] I have a check number.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I haven't found the claim number, but I will. I, I, um, yes, claim number.
[CUSTOMER][NEUTRAL] Hold on, check date, check number, policy number, reference number, claimant insured, claim number 3556784.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. And what is the patient's name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] All right, thank you. And [PII], what is a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] [PII]. Thank you.
[AGENT][NEUTRAL] OK, and this is for data service 11625?
[CUSTOMER][NEUTRAL] 116 25.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And I do have that claim pulled up. How can I help you?
[CUSTOMER][NEUTRAL] OK. I received the payment for $75.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I'm wondering um if there is any
[CUSTOMER][NEUTRAL] Patient responsibility on this.
[AGENT][NEUTRAL] Now this is a limited indemnity policy. We don't determine patient responsibility. We just pay the maximum benefit for that data service.
[CUSTOMER][NEUTRAL] That's what I thought, OK.
[CUSTOMER][NEUTRAL] OK, so, um, hmm.
[CUSTOMER][NEUTRAL] If you don't determine.
[CUSTOMER][NEUTRAL] OK, because we built 365.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Are you a multi plan? I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] So, it says that the
[CUSTOMER][NEUTRAL] Go ahead, go ahead.
[AGENT][NEUTRAL] Are you a multi plan provider?
[CUSTOMER][NEUTRAL] Yes, we are.
[AGENT][NEUTRAL] OK, so they will be eligible for that multi plan discounted rate. Now that is strictly through multi plan there's no contractual involvement in our processing of our claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so multiplied, um, multiple discounts will apply, obviously. OK, I'll see whatever that is and then um I'll, I'll figure it out from there. I'll be the patient for the balance, because we're only gonna discount what the contract says. OK, um, I have another one, it's gonna be a different patient, but before we move on, may I get a call reference number on this?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] The call reference number is my name and today's date.
[AGENT][NEUTRAL] And I spell my name [PII]
[CUSTOMER][NEUTRAL] I'm sorry, what's your name again? Uh-huh.
[AGENT][NEUTRAL] Yes, ma'am. [PII].
[CUSTOMER][NEUTRAL] Got it. OK, I have another patient whenever you're ready.
[AGENT][NEUTRAL] I'm ready for either claim number or policy number.
[CUSTOMER][NEUTRAL] Policy number 2455046.
[AGENT][NEUTRAL] And what is that patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Do you have that claim number or do we need to check claim status for you?
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] Checking the account further. OK, let's see if I have a claim number.
[CUSTOMER][NEUTRAL] Um, no. Does this plan cover, uh, primary insurance deductible with billing this one as a secondary?
[AGENT][NEUTRAL] Yes ma'am, for the covered services, but I can check that claim status for you. What is the date of service?
[CUSTOMER][POSITIVE] Appreciate it.
[CUSTOMER][NEUTRAL] It is uh [PII].
[AGENT][NEUTRAL] For [PII].
[AGENT][NEUTRAL] I don't have a claim on file for 126-24 and her policy is active for that data service.
[CUSTOMER][NEUTRAL] OK. So, 126 24, no claim. Um, may I verify your address? I have an address listed as of
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, so you don't have to claim. OK, um, I'll go ahead and, um,
[AGENT][NEUTRAL] You can
[CUSTOMER][POSITIVE] Flex it.
[AGENT][POSITIVE] Yes you can. I'm sorry.
[AGENT][NEUTRAL] I can provide that claim, um, fax number for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] It'd be great thank you.
[AGENT][NEUTRAL] The fax number is 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][POSITIVE] 877-3659423. OK, thank you so much for your help. Have a great rest of your day.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Oh, it's been a pleasure to assist you. Anything else I can help you with, [PII]? Oh, and we will need the primary EOB on this on this claim.
[CUSTOMER][NEUTRAL] The view.
[CUSTOMER][POSITIVE] Got it, appreciate it, thank you.
[AGENT][POSITIVE] Oh, thank you for calling APL and I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye-bye.