AccountId: 011433970860
ContactId: d8c6776d-6403-4c64-9e99-37c2fdae7763
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 458700 ms
Total Talk Time (AGENT): 156861 ms
Total Talk Time (CUSTOMER): 184683 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/d8c6776d-6403-4c64-9e99-37c2fdae7763_20250102T16:40_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check on a claim status.
[AGENT][NEUTRAL] OK, yeah, I can check on a claim for you, [PII]. Uh, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, [PII], I got, uh, could you repeat that phone number for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, and then do you have the policy number?
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Uh, it's 413-278-999.
[AGENT][NEUTRAL] I'm sorry, [PII], it's a bit difficult to hear you. Um, was that 413.
[CUSTOMER][NEUTRAL] 413-278-99997
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, that's gonna be a bit too long to be one of our policy numbers [PII].
[AGENT][NEUTRAL] You have their social I could search for them that way.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah, the Social Security is [PII].
[AGENT][NEUTRAL] OK, so that was their social that you gave me?
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Yes, can I give the patient's first name and last name?
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Can I give the patient first name and last name?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] The first name is [PII] and the last name is [PII], [PII]
[AGENT][NEUTRAL] OK, yeah, I didn't get that with the social um let me try searching just using the name. Give me just a moment.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Uh, what state does, uh, this patient live in?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, do you have the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK thank you
[AGENT][NEUTRAL] That was [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, bear with me just a moment. I'm not finding them in our system.
[CUSTOMER][NEUTRAL] Oh, sorry, sorry, sorry. I'm giving the wrong number. Can I get the first member ID? I have the member ID.
[AGENT][NEUTRAL] Oh you do OK.
[CUSTOMER][NEUTRAL] Is 02536197?
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um, what was the name for the patient?
[CUSTOMER][NEUTRAL] [PII] and the last name is [PII].
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] What was the date of birth?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I got it. Alright, thank you for verifying all of that. Uh, what was the date of service for this claim?
[CUSTOMER][NEUTRAL] 2, sorry, [PII], but the bill amount the $265 even.
[AGENT][NEUTRAL] OK, that was 10-8-2024.
[CUSTOMER][NEUTRAL] OK, that was
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment please, and this was for [PII], correct?
[CUSTOMER][NEUTRAL] Mhm OK.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, I'm not showing that we have any claims on file uh for.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] This patient.
[CUSTOMER][NEUTRAL] Uh, it's 108-2024 with the billed amount to $65 even.
[AGENT][NEUTRAL] Right, I'm not showing that we received that claim.
[CUSTOMER][NEUTRAL] But previous one stated the claim was received on [PII]. I have the claim number also. We have requested the UB.
[AGENT][POSITIVE] OK, yes, please give me that claim number that would be great.
[CUSTOMER][NEUTRAL] 3521417
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so that is for a different policy number than the one that you had given me. Give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] Sorry, could you repeat it once again?
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Could you repeat it once again?
[AGENT][NEUTRAL] Yeah, so the uh the policy number is different for the claim number that you gave me. Um, the policy number for this one is uh 02536267.
[CUSTOMER][NEUTRAL] So this one is um
[CUSTOMER][NEUTRAL] 536.
[CUSTOMER][NEUTRAL] Yeah. OK. Thank you. And what is the status of the claim?
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So for this claim it's stating that we were unable to pay a benefit as the calendar year maximum on diagnostic services has been met.
[CUSTOMER][NEUTRAL] So for these.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, OK. Can I get a copy of COB?
[AGENT][NEUTRAL] Of course did you have a fax number?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah, I have the fax number. The fax number is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm gonna read that back, make sure I heard that correctly, that was [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and when I just put this to your attention, [PII]?
[CUSTOMER][NEUTRAL] OK, I'm I just
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, alright, I will get that sent to you uh was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Alright, I will get that sent to you. Um is there anything else I can help you with? Yeah, I have another claim under the same number.
[AGENT][NEUTRAL] This is for the same number you said?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, did you have that claim number?
[CUSTOMER][NEUTRAL] OK, did you have that
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm ready for that claim number.
[CUSTOMER][NEUTRAL] The, the claim number is 3521416.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment. OK, so for this claim it was not a covered diagnostic test, so we were unable to pay a benefit.
[CUSTOMER][NEUTRAL] So far this also I need the caller he will be.
[AGENT][POSITIVE] Of course I'll get that one sent to you as well.
[CUSTOMER][POSITIVE] Of course I'll get that one sent to you as well.
[AGENT][NEUTRAL] OK, did you have any other questions for me?
[CUSTOMER][NEUTRAL] Yeah, that's all.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yeah, that's right. Can I get the call reference number?
[AGENT][NEUTRAL] Yeah, reference number would just be my first name, last initial, and today's date and so name is spelled [PII]
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And can I get your name?
[AGENT][NEUTRAL] It's [PII] last initial is [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Yeah, OK. Thank you so much for your patience and help. Have a great day.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.
[CUSTOMER][POSITIVE] Thanks
[CUSTOMER][NEUTRAL] Bye.