AccountId: 011433970860
ContactId: dd383620-ff94-4e37-81a6-0420d4ee7cad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1228469 ms
Total Talk Time (AGENT): 193665 ms
Total Talk Time (CUSTOMER): 253560 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=-1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/dd383620-ff94-4e37-81a6-0420d4ee7cad_20250516T18:05_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi this is [PII].
[CUSTOMER][NEUTRAL] We are on the provider offers and we are checking on the claim status for the member here and may I have your name again?
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh, so, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, may I have a callback number just in case we get disconnected, Mr. S?
[CUSTOMER][NEUTRAL] Yeah, that is [PII]. That's a direct line.
[AGENT][NEUTRAL] OK, what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] So we are from Elias Dermatology.
[AGENT][NEUTRAL] OK. And may I have the patient's policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yeah, that is 16,460.
[AGENT][NEUTRAL] Is that all the numbers you have?
[CUSTOMER][NEUTRAL] Yeah, so this is the number I have.
[AGENT][NEUTRAL] Um, OK, bear with me number, so I will have to pull the whole group. It might take a few minutes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, while I wait on the group, may I have the spelling of the last name and the first name?
[CUSTOMER][NEUTRAL] OK. So the last name is [PII], which is [PII].
[CUSTOMER][NEUTRAL] And the first name is [PII], which is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, what's the date of birth?
[CUSTOMER][NEUTRAL] So her date of birth is July, sorry, [PII].
[AGENT][NEUTRAL] OK, thank you. What's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah, that is for [PII]. And total amount is $331.42.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] OK, let me see if I can find this claim, and for future you can check claim status online through our website at [PII], and that's just optional.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Um let's see.
[AGENT][NEUTRAL] OK, 21. OK, let me pull this COV one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're waiting on the system.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] No problem. Take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] I'm gonna put you on a brief hold, OK?
[CUSTOMER][NEUTRAL] Yeah, OK, no problem. Mhm. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. OK, um, I don't have the image of the EOB, but I do have the information that I can give to you. It looks like we received the claim on [PII] and we processed the claim on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Yeah.
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] We send a benefit amount of $39.60.
[CUSTOMER][NEUTRAL] $39.60 60 right?
[AGENT][NEUTRAL] Yes, 60. Mhm.
[CUSTOMER][NEUTRAL] OK, so the claim is paid?
[AGENT][NEUTRAL] Yeah, we pay 39.60. The only denial that I see on the claim is the office visit. Office visits are not covered, we only cover procedures.
[CUSTOMER][NEUTRAL] Yeah, we
[CUSTOMER][NEUTRAL] OK, that is not an issue so because uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh let me double check that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So this is for AVM, right? Oh, sorry.
[CUSTOMER][NEUTRAL] This is for American Public Life, right? OK, perfect. And uh, may I, may I have the details about like the payment details? So when the payment is issued and whether it is a check or EFT, what was the check?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, it is a check.
[CUSTOMER][NEUTRAL] Status on the claim number.
[AGENT][NEUTRAL] It is a check, it's a single check.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The check number is 2033857.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The check on the date on the check is the same date of the process.
[CUSTOMER][NEUTRAL] It showed on [PII], right? OK.
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] May I have the claim number?
[AGENT][NEUTRAL] Sure. The claim number is 357-7967.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Uh, can you please verify me the pay to address on the check?
[AGENT][NEUTRAL] I'm not gonna have that information. I was not able to pull the image of the claim. I just have general information.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, so how I can able to like uh have the check status on this. So I want to know whether it is cash or not about the check status.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] If you can wait for me a little bit longer in the line, I can try to get that information manually.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment. Mhm.
[CUSTOMER][POSITIVE] Uh, make it as soon as possible. Yeah, thank you.
[AGENT][NEUTRAL] I'll try, but I'm I'm getting the information manually because I don't have an image, OK? So bear with me.
[CUSTOMER][NEUTRAL] Option.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] No problem at all. Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding.
[AGENT][NEUTRAL] OK, um, it looks like it cleared on [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, perfect. And may I, can you please verify me the address also on that?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Pay to address.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Yes, it was [PII].
[CUSTOMER][NEUTRAL] Perfect. Yeah, thank you for the confirmation on that. And OK, still now we didn't receive that EUB from your side, right? Is it possible to send me the copy of EUB via fax?
[AGENT][NEGATIVE] I'm not able to get an image of the ELB right now. That's why I had to get everything manually.
[CUSTOMER][POSITIVE] Yeah, you can.
[AGENT][NEUTRAL] I can give you the, the claim number and you can get it online if you would like.
[CUSTOMER][NEUTRAL] Yeah, so you know which, uh, is it an open portal or you want me to get it on, uh, in a registered portal?
[AGENT][NEUTRAL] You have to register.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK, so may I have the website first?
[AGENT][NEUTRAL] Sure, that's [PII].
[CUSTOMER][NEUTRAL] [PII], right? OK, let me double check that.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so let me double check.
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] And for [PII], right? [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. OK one moment. Oh, I missed this see.
[CUSTOMER][NEUTRAL] Uh, OK, so that is [PII]. OK. So in that we can able to register and after that we can able to get the, get this, uh, AB from outside, right? OK.
[AGENT][NEUTRAL] Yes, you can get the image of the EOB. Mhm.
[CUSTOMER][NEUTRAL] OK, perfect. So, may I have the call reference number on this one?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] Yeah, so that is [PII], right?
[AGENT][POSITIVE] Mm. Correct.
[CUSTOMER][POSITIVE] OK, perfect. Thanks so much, so, and much appreciated and thank you so much for your patience and all this.
[AGENT][POSITIVE] OK, you're welcome and thank you for calling APO. Have a good afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye-bye.