AccountId: 011433970860
ContactId: df2a2294-8b4c-40c6-b074-c18b7d2ab8d6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 980599 ms
Total Talk Time (AGENT): 256035 ms
Total Talk Time (CUSTOMER): 283009 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/df2a2294-8b4c-40c6-b074-c18b7d2ab8d6_20250211T14:13_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] Hi, this is [PII] calling from the doctor's office.
[AGENT][POSITIVE] Hi [PII], how are you doing today?
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] Yeah, correct. What I would do, you mean?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Yeah, [PII]. Uh, I just need to know the claim status for a number and, uh, if possible, I need to register for number 4.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I mean, for the portal, yeah.
[AGENT][NEUTRAL] You said you need claim status?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, a total of 20.
[AGENT][NEUTRAL] 20 claims?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We're going to be able to do 5 on the phone. You can also go to our online service center and get claim status as well.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] Let's go right on.
[AGENT][NEUTRAL] [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the first member's policy number?
[CUSTOMER][NEUTRAL] Yeah, the member's policy ID number, uh.
[CUSTOMER][NEUTRAL] 02465170 M as in Mike, L as in Lima 8 number 8.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah. My first and last name would be.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] Yeah, the date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] Yeah, it's for $397 even.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Hello, [PII]? Yeah, sure.
[AGENT][NEUTRAL] OK, so we actually haven't processed any claims for you, [PII]. Um, let me see if there's another policy. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so this is the only policy that was active on the date of service, but there's no policy or there's no claims on file. You can um still send the claim to be processed. There's no timely filing limit.
[CUSTOMER][NEUTRAL] Uh, no claim on file. Um, I guess for the date of service, right?
[AGENT][NEUTRAL] Yes, the policy was active on the data service, but there's no claim on file.
[CUSTOMER][NEUTRAL] OK. Uh, what is the time of filing limit?
[AGENT][NEGATIVE] There is no timely filing limit?
[CUSTOMER][NEUTRAL] OK. Uh
[CUSTOMER][NEUTRAL] Can you give me the address?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Could you give me the address?
[AGENT][NEUTRAL] The address is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][POSITIVE] All right, perfect.
[CUSTOMER][NEUTRAL] Uh, will it be a caller transfer number or complete call?
[AGENT][NEUTRAL] Um, for the entire call, it will be my name and today's date.
[CUSTOMER][NEUTRAL] Sure, [PII]. Thank you. Which model next number?
[AGENT][POSITIVE] Yes, we're ready for the next member.
[CUSTOMER][NEUTRAL] Yeah, I remember I is.
[CUSTOMER][NEUTRAL] 07, just a sec, sorry. The member ID is
[CUSTOMER][NEUTRAL] Could you check with the member's name and date of birth?
[AGENT][NEUTRAL] OK, what's the member's first and last name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And can you spell the last name for me, please?
[CUSTOMER][NEUTRAL] Uh, yeah, it is.
[CUSTOMER][POSITIVE] [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Yeah. Perfect.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so we don't have a member with the name or a policy with the name [PII] on it. Is that the policyholder?
[CUSTOMER][NEUTRAL] Uh yeah.
[AGENT][NEUTRAL] What's the middle initial?
[CUSTOMER][NEUTRAL] Uh, just a sec. Let me just check. I remember ID.
[AGENT][NEUTRAL] No, just the middle initial.
[CUSTOMER][NEUTRAL] Yeah, I'm just checking.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] OK, so this may be it. Hold on one moment.
[CUSTOMER][NEUTRAL] I think it
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And can you verify the member's date of birth?
[CUSTOMER][NEUTRAL] Yeah, the number's date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Yeah, the date of service is 85-24.
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] Yeah, the total bill amount is $27 even.
[AGENT][NEUTRAL] 27
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, hold on one moment. And that's [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so there's no claim on file for [PII] for [PII].
[CUSTOMER][NEUTRAL] Could I get the member ID?
[AGENT][NEUTRAL] 239-057-9.
[CUSTOMER][POSITIVE] Perfect. Uh, is there a group number?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Group number is 243.
[AGENT][NEUTRAL] 68.
[CUSTOMER][POSITIVE] Perfect. Uh, could I get the active dates for the number?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] The policy was active from [PII].
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] I'll just send the claim back.
[CUSTOMER][NEUTRAL] For first name. Uh, let's go with the last name for this. Sorry, I do have, uh, other claims. Yeah. Let's go with the next number.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah, it is 02483110.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] Yeah, the date of birth is uh [PII].
[AGENT][NEUTRAL] Thank you and again just for the call, 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 bills?
[CUSTOMER][NEUTRAL] Yeah, the date of service is uh [PII] with the bill amount of $1,424 even.
[AGENT][NEUTRAL] So [PII] $1,424.
[CUSTOMER][POSITIVE] Yeah, perfect, [PII].
[AGENT][NEUTRAL] Hold on one moment. So there's no claim on file for [PII]?
[CUSTOMER][NEUTRAL] Is the member active for the date of service?
[AGENT][NEUTRAL] Yes, um, hold on one moment.
[AGENT][NEUTRAL] The policy is still active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] [PII] to the date, right?
[AGENT][POSITIVE] Correct, it's still active.
[CUSTOMER][NEUTRAL] OK. Uh, could I get the payer ID?
[AGENT][NEUTRAL] Sure, it's 60801.
[CUSTOMER][POSITIVE] Perfect. Let's move to the next number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, and my ID is.
[CUSTOMER][NEUTRAL] 01681855 M as in Mike, L as in Lima, number 8.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Yes, I'm waiting for the first and last name and date of birth.
[CUSTOMER][NEUTRAL] Sorry. Uh, the patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[AGENT][NEUTRAL] And the total bill?
[CUSTOMER][NEUTRAL] Yeah, the total bill is $302 even.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] OK, so there's no claim on file for [PII] for that data service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Active data services.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Actor coverage from?
[AGENT][NEUTRAL] Um, the policy has been active since, um, sorry, [PII] and it's still active.
[CUSTOMER][NEUTRAL] [PII], the date.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Let's move on to the next thing.
[AGENT][NEUTRAL] OK, the next member?
[CUSTOMER][NEUTRAL] Yeah, the next one is.
[CUSTOMER][NEUTRAL] Uh, the member ID is 239-0575.
[CUSTOMER][NEUTRAL] The name [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] [PII], uh, the name is [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] Yeah, the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] Yeah, the date of [PII] uh [PII].
[CUSTOMER][NEUTRAL] With the bill amount of $455 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And there's no claim on file for [PII] for [PII].
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Activ dates are?
[AGENT][NEUTRAL] Um, it's still, uh, hold on, let me see, let me make sure.
[AGENT][NEUTRAL] It was active from [PII].
[CUSTOMER][NEUTRAL] OK we'll follow.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Let's go on to the next plane.
[CUSTOMER][NEUTRAL] Shall we?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so that was the 5 claims. Are you um on the online service center?
[CUSTOMER][NEUTRAL] No, uh, could you give me the patient account number? I got stuck here, the patient account number.
[AGENT][NEUTRAL] For the one we just went over?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well, there's no claim on file. We received the account numbers with the claim from the provider, so that actually comes from you all, but there's no claim on file, so I can't give the, we don't have um account number because there's no claim.
[CUSTOMER][POSITIVE] Sure. Thank you.
[CUSTOMER][POSITIVE] Thank you, [PII]. I wish you a great day.
[AGENT][POSITIVE] Thank you, [PII]. You also, and thanks for calling APL. I hope you have a great day as well.
[CUSTOMER][NEUTRAL] Yeah. Bye.
[AGENT][NEUTRAL] Bye bye.