AccountId: 011433970860
ContactId: d79c307e-ee32-437b-8698-a7f764002e33
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 556099 ms
Total Talk Time (AGENT): 201848 ms
Total Talk Time (CUSTOMER): 105981 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/d79c307e-ee32-437b-8698-a7f764002e33_20250319T12:58_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] Hey, hello and uh good morning. This is [PII]. Last name is [PII]. I'm calling from provider office to verify the claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII]. May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], I'm sorry, it's [PII].
[AGENT][NEUTRAL] Thank you. And may I have the member's policy number?
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yeah, the policy number is 1484324.
[AGENT][NEUTRAL] 1484324
[CUSTOMER][NEUTRAL] 1484324, yes.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. It's [PII]. Uh, date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure, the date of service is [PII].
[CUSTOMER][NEUTRAL] Excuse me. Uh, the total charge amount is $2,0025 even.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I'm actually showing that the claim, the policy number you provided um was not active on the date of service. It was active from [PII], but there was an active policy on your date of service. That policy is 2,123,550.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I'll go ahead and check that policy to see if there's a claim there for you.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] $2,225 or $2,025?
[CUSTOMER][NEUTRAL] It's 2025. 22025.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][POSITIVE] Yeah, it's Correct Vision Laser Institute.
[AGENT][NEUTRAL] OK, here we go.
[CUSTOMER][NEUTRAL] now, ma'am.
[AGENT][NEUTRAL] So I'm trying to received the claim on [PII].
[AGENT][NEUTRAL] My claim number is 3501588.
[AGENT][NEUTRAL] And on [PII], um, we denied the claim, requesting the explanation of benefits from primary insurance.
[CUSTOMER][POSITIVE] Uh yes, um, uh, sorry for interrupt you.
[AGENT][NEUTRAL] And then we
[CUSTOMER][NEUTRAL] So if I drop you in between, actually, I just uh uh send the, uh, I just faxed the claim with the primary UV um on fax number [PII].
[AGENT][NEUTRAL] Yes, what I was gonna, what I was going to say to you was we received another claim on [PII] and it was denied as a duplicate. So let me take a look at the um the documents that was received. So yes, we did receive it. Hold on one moment, OK?
[CUSTOMER][NEUTRAL] So, do you guys receive that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] I thought I pulled it.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEGATIVE] It was denied request an explanation of benefits from property, so this is it's denied as a dupe.
[AGENT][NEUTRAL] That means we didn't receive it, so let's check.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Oh wait, no, that's not what I want.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So we, from what we received, it was the claim form from the provider, but on the second page, uh, this is not an explanation of benefits. The explanation of benefits needs to be from the um primary insurance. This is, it's not really legible, but from what you do see, it's not, this is more of like a remittance or like there's no, there's
[AGENT][NEUTRAL] This isn't an explanation of benefits from a primary insurance company. So their primary insurance.
[AGENT][NEUTRAL] It's Blue Cross Blue Shield, so usually it'll have their logo to the top left, it'll have this is not a bill on it. This is an explanation of benefits and then it'll show all the charges and what was applied and what's left over.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Just bear with me.
[AGENT][NEUTRAL] Yeah, there's not even a heading on this document. So yeah, um, we just need a uh
[AGENT][NEUTRAL] Official explanation of benefits or a copy, it doesn't even have to, it can be a copy of the explanation of benefits from Blue Cross Blue Shield.
[AGENT][NEUTRAL] For this data service.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Just bear with me, OK?
[CUSTOMER][NEUTRAL] Just bear with me, OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just bear with me, ma'am, OK?
[AGENT][POSITIVE] Sure, that's fine. Take your time.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, one.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] How many email that.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] I'm here.
[CUSTOMER][NEUTRAL] Uh yes. Uh, I didn't get your name. Your name is?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] [PII], OK. Uh, OK, and another, the fax number which I have provided you, uh, the correct one, right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] That's the correct fax number, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, no worries. I'll be sending uh again, OK?
[AGENT][NEUTRAL] All right, well, was there anything else I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] Uh, no, thank you so much. Just help me out with the reference of this call.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date.
[CUSTOMER][POSITIVE] OK, no worries. Thank you so much.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL Ari and have a great day.
[CUSTOMER][POSITIVE] You too bye bye take care.
[AGENT][NEUTRAL] Bye bye.