AccountId: 011433970860
ContactId: d09b0766-9056-4384-bcb8-d77f42dba365
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 643919 ms
Total Talk Time (AGENT): 266373 ms
Total Talk Time (CUSTOMER): 194436 ms
Interruptions: 6
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/d09b0766-9056-4384-bcb8-d77f42dba365_20250121T16:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] with whom am I speaking. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. My name is [PII]. I'm calling you from the uh provider office, specialty care surgical assist, and I'm looking for claims information for a patient today.
[AGENT][NEUTRAL] OK, what's a good call back number for you, [PII], in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh, sure. Phone number is area code [PII]. It's a direct line.
[AGENT][NEUTRAL] OK, thank you and what is the policy number you're calling regarding?
[CUSTOMER][NEUTRAL] Uh-huh. Patient's ID I have here.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] 1954796.
[AGENT][NEUTRAL] Thank you for that information, [PII]. So once I get that policy pulled up, I'm gonna have you verify some information and then I'll be able to assist you with the status of a claim verification of coverage does not guarantee the payment of claim. Just allow me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To get that pulled up, what is the member's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, patient name, it's.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm gonna repeat that policy number you gave me. Did you say 1954796?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, that policy number does not match the name you gave me nor date of birth.
[AGENT][NEUTRAL] So let me try to search by that name, give me one moment.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Spell the last name?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The patient last name.
[CUSTOMER][NEGATIVE] [PII].
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] First name, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you're calling checking the status of a medical claim, is that correct?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you for your patience. One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, I have the correct policy number for you. Let me know when you're ready.
[CUSTOMER][NEUTRAL] OK, yes, I am.
[AGENT][NEUTRAL] 256
[AGENT][NEUTRAL] 8914.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the data service and uh charge amount you're looking for?
[CUSTOMER][NEUTRAL] Sure, the bill charges I have here $745 even.
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] Date of service is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] One moment, please.
[CUSTOMER][NEUTRAL] Mhm, sure.
[AGENT][NEUTRAL] Now that policy number I gave you is for claims data service [PII] and after, so the policy number for this particular one looks like you had the last digit wrong 195.
[AGENT][NEUTRAL] 479-5 and give me one moment I'll check to see if I can find it.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, that's the ID I have.
[AGENT][NEUTRAL] Well, you told me 196 and I, I read it back to you, you say yes, OK, so you had the last digit wrong. Mhm. OK. Give me one moment to locate that coin.
[CUSTOMER][NEUTRAL] OK, yeah, sure. Right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Right, right. Correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we have a claim number 353.
[AGENT][NEUTRAL] 7106 and one moment while I get the details.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm showing it was received on [PII]. It was denied on [PII], and the reason for denial is because we need the primary ELB that shows the patient responsibility. The LB that was submitted with this claim does not show patient responsibility in the form of a copay, co-insurance or deductible, so we need the correct ELB that shows that, right?
[CUSTOMER][NEUTRAL] OK, and.
[CUSTOMER][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] I made a call and spoke with [PII], yeah.
[AGENT][NEUTRAL] That's when it was
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see, let me go back and look.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Let me take a look at the notes. You go ahead and tell me.
[AGENT][NEUTRAL] What, um, I'm gonna read it.
[CUSTOMER][NEUTRAL] Sure. And here, uh, state that claim process on [PII].
[CUSTOMER][POSITIVE] And paid $745 on the single check number 2004944 and it's still outstanding.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Let's take a look again and see what I do see [PII]'s note in there. I'm not sure why they would process that and not allow it to make a payment if it originally made a payment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm. So as the check was still outstanding, I sent the uh check tracer to find out if the payment was sent to the correct uh address or if the check was already bounced.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so I'm gonna send, I'm gonna send her an.
[CUSTOMER][NEUTRAL] And the check has been.
[CUSTOMER][NEUTRAL] Mhm. Go ahead.
[AGENT][NEUTRAL] I'm gonna send, I'm gonna send [PII] an email.
[AGENT][NEUTRAL] And I'm gonna have her uh return a call to you because I'm not sure why this was hold on let me see who processed it first. Give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] just because you spoke to [PII] don't mean she processed it.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Let's see, she did not process this here.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And I, uh, uh, you said your name is [PII], right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK. And also I spoke with you on [PII].
[CUSTOMER][NEUTRAL] And also you said the same thing on [PII]7 claim process paid 745 payment issued under check number 20094944 still outstanding.
[AGENT][NEUTRAL] Mhm and I do see my note where I spoke to you on [PII] I I see my note where I spoke to you and what I'm explaining to you, [PII], is you don't have to explain it any further. I see what has happened and I'm going to reach out to see why it was not processed correctly. I'm gonna place you on hold, OK? One moment. Thank you.
[CUSTOMER][NEUTRAL] Yeah, [PII], yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right, OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for patiently waiting, [PII]. I have sent the email to the adjuster who originally processed that claim and who was who was sent a request.
[CUSTOMER][NEUTRAL] You're welcome. Mhm.
[AGENT][NEUTRAL] To reissue to the check and unfortunately she did not issue a payment. So an email has been sent to for her to issue a a payment and I will have her return a call to you at the number you gave me [PII] and ask for [PII] when it is completed. OK, anything else I can help you with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. Now, that's all I need. And you said the email was sent to Roxy or to whom?
[AGENT][NEUTRAL] No, I, I can't give you the name of who it's being sent to. It's being sent to the adjuster who adjusts the claim, and that that is not [PII]. Roxy just took your phone call just like I took your phone call on [PII] of today, but we did not adjust the claim, so it's going to the person that adjusted the claim, OK? Anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, right. Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Mhm. All right.
[CUSTOMER][POSITIVE] Uh, no, that's all I need. Thank you so much for your help. And I would like to have a reference number. Mhm.
[AGENT][POSITIVE] All right. Thank you, [PII]. You're welcome.
[AGENT][NEUTRAL] It's gonna be my name [PII], last initial [PII] and today's date. That'll be your reference for the call. Thank you, [PII], for calling APL. We apologize for the inconvenience, OK. Mhm. Bye bye. Thanks for calling APL uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Thank you so much. That's all I need.
[CUSTOMER][POSITIVE] No problem, that's fine. mhm, have a good.