AccountId: 011433970860
ContactId: e093783a-41f7-4126-82e2-848e6bd73322
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 553219 ms
Total Talk Time (AGENT): 131487 ms
Total Talk Time (CUSTOMER): 215998 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/e093783a-41f7-4126-82e2-848e6bd73322_20250404T19:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning. Well, it is not morning, good afternoon.
[CUSTOMER][NEUTRAL] Yes, I was needing to check claim status for a patient.
[AGENT][NEUTRAL] OK, I can help you with claim status. Could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[CUSTOMER][NEUTRAL] Phone number is [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yes, I'm sorry, what was your name again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], OK, yes, um, the policy number I have is um 018.
[CUSTOMER][NEUTRAL] 22342.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] Um, so the first name I have is [PII], last name is [PII]. I have date of birth of [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And what was that date of service?
[CUSTOMER][NEUTRAL] OK, so the date of service was [PII] and the total bill amount was $184 even.
[AGENT][NEUTRAL] OK, [PII] and [PII] is the patient?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let me see, this policy number that you gave me is terminated. Let me see if she's got a different one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, it looks like she does. Let me get that pulled up.
[AGENT][NEUTRAL] OK, um, her actual active policy number, do you want that number?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Um, it's 246-288-1.
[CUSTOMER][NEUTRAL] OK, so that other um number, when did that one time?
[AGENT][NEUTRAL] Uh, that one turned 121-2023.
[CUSTOMER][NEUTRAL] [PII] of 2023. So did she have insurance coverage on this data service?
[AGENT][NEUTRAL] What was the date of service again? I'm sorry.
[CUSTOMER][NEUTRAL] No, it's OK. [PII].
[AGENT][NEUTRAL] Um, yes, she's, she's got coverage. Um, I just don't have a claim on. Oh, well, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Sorry, just a second.
[AGENT][NEUTRAL] See
[AGENT][NEUTRAL] And you said [PII]?
[CUSTOMER][NEUTRAL] Yeah. Mhm.
[AGENT][NEUTRAL] OK 184, is that right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yes, I do have that claim on file. Let me get that pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Uh, it looks like we received it 224-25. It was denied on 225 25, and that reason was.
[AGENT][NEUTRAL] Office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] And so, um, is there a way that you can send me an EOB for that?
[AGENT][NEUTRAL] Sure, what's your fax number?
[CUSTOMER][NEUTRAL] OK, fax number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, I'll get this faxed over. It just takes a few minutes. Is there anything else I can help with today?
[CUSTOMER][NEUTRAL] OK. And can you
[CUSTOMER][NEUTRAL] Um, can you attention it to [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Please, OK, and do we have a call reference number?
[AGENT][NEUTRAL] Uh, call reference number is just my first name, [PII], and then first initial last name is [PII] as [PII], and today's date.
[CUSTOMER][NEUTRAL] All right, OK, well thank you so much, Ms. [PII]. um, I think, hold on, let me make sure.
[CUSTOMER][NEUTRAL] Oh yeah, she got a few claims. How many claims can we inquire about um for a patient?
[AGENT][NEUTRAL] Is this for the same patient?
[CUSTOMER][NEUTRAL] Mhm yeah.
[AGENT][POSITIVE] Uh, yeah, I, I mean, I can help you with however many.
[CUSTOMER][NEUTRAL] I can just do one more if.
[CUSTOMER][NEUTRAL] OK, I can just do one more then I'll um I'll probably call back after my break. So the second day of service is um [PII]:31 of 24.
[AGENT][NEUTRAL] And the build out?
[CUSTOMER][NEUTRAL] And that total bill amount is $184 even.
[AGENT][NEUTRAL] And it was 10:31 2024 and that's same patient, right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, that one I
[CUSTOMER][NEUTRAL] Actually, oh, that might be for they got the same last name, but I think let me see.
[CUSTOMER][NEUTRAL] It might be for her that might be her husband.
[CUSTOMER][NEUTRAL] Yeah, so that's a whole totally different patient. It says for um.
[CUSTOMER][NEUTRAL] I guess I could give you that member ID number.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what's the other policy number?
[CUSTOMER][NEUTRAL] All right, it is um.
[CUSTOMER][NEUTRAL] It is 1. OK, it is 024.
[CUSTOMER][NEUTRAL] 628.
[CUSTOMER][NEUTRAL] 81
[CUSTOMER][NEUTRAL] That's the member ID you gave me for that last patient.
[AGENT][NEUTRAL] Yeah, so is that, are we checking on the same patient or?
[AGENT][NEUTRAL] Or different.
[CUSTOMER][NEUTRAL] No, because this one is, yeah, this one I'm guessing this is her husband, um, [PII], first name is [PII], last name is [PII].
[CUSTOMER][NEUTRAL] Um, I have a birthday of [PII].
[AGENT][NEUTRAL] OK, what and what was that date did you say?
[CUSTOMER][NEUTRAL] Um, [PII] of 24.
[CUSTOMER][NEUTRAL] And the total bill amount is $184 even probably say offices covered.
[AGENT][NEUTRAL] Um, looks like we processed that on [PII].
[AGENT][NEUTRAL] And let's see.
[AGENT][NEGATIVE] And that was denied office visits are not covered for the policy.
[CUSTOMER][NEUTRAL] OK, and when was that claim received?
[AGENT][NEGATIVE] Uh, that was received 122-2024 and then denied 124 2024.
[CUSTOMER][POSITIVE] OK, alrighty then and then is it a, OK, I'll just use your name for that reference number for this one too. OK, alright, well thank you so much, Ms. [PII].
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, thank you for calling APL and I'll get uh that one claim or EOB faxed.
[CUSTOMER][NEUTRAL] OK, alright. Oh, actually, let me see if if I got an EOB for this one because I might need that one faxed as well.
[CUSTOMER][NEUTRAL] OK, yeah, it, can you fax that one to me as well for this patient?
[AGENT][POSITIVE] Yes, I'll fax that one too.
[CUSTOMER][POSITIVE] Perfect. OK, alright. Well, thank you so much and have a good day.
[AGENT][POSITIVE] Thank you. You as well.