AccountId: 011433970860
ContactId: e46787d9-b75b-4bcb-bc71-74ddfa1a6d8b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1148290 ms
Total Talk Time (AGENT): 428606 ms
Total Talk Time (CUSTOMER): 414935 ms
Interruptions: 2
Overall Sentiment: AGENT=2.5, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/e46787d9-b75b-4bcb-bc71-74ddfa1a6d8b_20250228T15:06_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. My last insurance that you and I would like to check the status of the claim. Would you be able to help me with that?
[AGENT][POSITIVE] Yeah, I'd love to help you with claim status today. Do you mind if I get the policy number for the patient we wanna look at today?
[CUSTOMER][NEUTRAL] Yeah, sure. So the first patient policy number, it is 01891850.
[AGENT][POSITIVE] Perfect. Give me 1 2nd to get all of that pulled up for you.
[CUSTOMER][POSITIVE] Mhm. Sure. Thank you so much. And may I also have your name spelled with the last name for documentation purpose?
[AGENT][NEUTRAL] Yes, you betcha. My name is [PII] Last initial is [PII].
[CUSTOMER][POSITIVE] Thank you so much, [PII].
[AGENT][NEUTRAL] My pleasure. And could you verify for me, please, the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, sure. My first name is [PII], last name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Perfect thank you so much and Miss [PII], I'm sorry I should have asked just a moment ago, but do you mind if I snag a good call back number for you as well today?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Sure, no issues. I have it. The callback number it is [PII].
[AGENT][POSITIVE] Beautiful, thank you. And for Ms. [PII], what is the date of service we're looking at on her claim?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh, for this claim, uh, it is the date of service of for number [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm. Yes.
[AGENT][POSITIVE] Perfect. And the billed out?
[CUSTOMER][NEUTRAL] $151 even.
[AGENT][POSITIVE] Perfect. Thank you. Give me just one second to find that for you.
[CUSTOMER][POSITIVE] Mhm. No issues. Take your time.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Would you be able to verify for me, I'm so sorry. I think this is it.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Give me 1 2nd to get this pulled up real fast.
[CUSTOMER][NEUTRAL] Mm. Now, wait a second. Take your time.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] Loading.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Now
[AGENT][NEUTRAL] There it is. OK, now can you verify for me pretty please the name of the facility on the claim?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm. The facility name is May Clinic.
[AGENT][POSITIVE] Perfect. All right, I do see your claim here and I'm showing that the claim, it looks like.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Move to the screen again. Your claim was received on [PII]. I have your claim number listed as 3248481, and that claim was processed on [PII]. It does look like that claim denied. I have the reason stating that the policy does not provide.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Any benefits um for expenses and cured for the pregnancy of a dependent child.
[CUSTOMER][NEUTRAL] Oh, OK. Uh, one second.
[CUSTOMER][NEUTRAL] You said the policy does not provide any benefit to the dependent child, right? For the pregnancy of dependence, sir.
[AGENT][NEUTRAL] The policy
[AGENT][NEUTRAL] Yeah, for any expenses incurred for the pregnancy of a dependent child.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. Give me a minute. Let me document it here.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for being patient, Ali. So I have got, mhm you're welcome. And I have got it uh documented. Thank you for that. And actually, I don't have any EOB with me. Is there any possibilities that you could fax me the EOP?
[AGENT][POSITIVE] No worries.
[AGENT][POSITIVE] Yeah, I can definitely get that EOB faxed over to you. Grab me give me one second to pull it up.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Mhm. Yes, sure. Take your time.
[AGENT][NEUTRAL] Miss [PII], are you gonna want this made attention to yourself or are you gonna want it made attention to that patient account number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] No, that should be in my name with my last initial.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is that last initial, Miss [PII]?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Thank you so much and what's the fax number we wanna send that to?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Fax number [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Perfect. And
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] perfect. I'm gonna send on that now. It takes anywhere from 5 to 15 minutes, but it should be coming your way and then you said I, if I'm not mistaken, you said you had additional um policies and claims we wanted to look at today, is that correct?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, correct. And before moving to the additional accounts, uh, for this claim, I can see that it is a patient of a child, right? The, uh, patient is a child.
[AGENT][NEUTRAL] Um, hold on, let me pull up.
[AGENT][NEUTRAL] Uh, they're [PII] now, it looks like, so in [PII], they would have been [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Perhaps, or turning [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] So, uh, 3 denial is right. OK. Thank you so much for that.
[AGENT][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] Just to uh m[PII], make a confirm. uh OK. Great. So, uh, whenever we're ready, uh, I'm ready with the next member ID here.
[AGENT][POSITIVE] OK, I am too. Let's do it.
[CUSTOMER][NEUTRAL] Mhm. OK. That's great. Then the next member ID it is 1191364.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And could you verify for me, please, um, the patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, sure, [PII]. So the patient's first name is [PII], last name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Perfect, I do see that and.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] That's great.
[AGENT][NEUTRAL] What is the date of service for [PII] that we wanna look at?
[CUSTOMER][NEUTRAL] State of service, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the total bill amount please?
[CUSTOMER][NEUTRAL] $331 even?
[AGENT][POSITIVE] Perfect, thank you.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] All right, so I see that claim here. It looks like we received the claim on [PII]. The claim number is 3143268, and the claim was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I do show that that claim, oh and also perfect um I do show that claim was also denied and the reason is stating is that office visits are not covered by the above numbered policy.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Mhm. OK, great.
[CUSTOMER][NEUTRAL] Does the patient has a meddling policy?
[AGENT][NEUTRAL] Uh, yes, this is one of the Medin policies, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much for that confirmation. So I would like to request to uh this I mean fax this EOB as well.
[AGENT][NEUTRAL] OK, yeah, let me pull up that EOB for you.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] service
[AGENT][NEUTRAL] And just to make sure I have that correct still 5854409493, is that correct?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Alright, I just hit send on that it should be coming your way as well and.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much for that.
[AGENT][POSITIVE] Perfect. And then are there any additional payments you want to look at today?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Yes, I like one last claim.
[AGENT][NEUTRAL] OK, and I am ready for that policy number.
[CUSTOMER][NEUTRAL] OK, then now we are good to go. So the next member ID it is 01670107.
[AGENT][NEUTRAL] And I'm so sorry, 016701117.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] 70.
[CUSTOMER][NEUTRAL] No, 70107.
[AGENT][NEUTRAL] I'm so sorry. I, can you just start that one all over for me? I don't know where my brain was at.
[CUSTOMER][NEUTRAL] Mm. Yes, sir. No issues. I can start over from the, I mean, I can start over again. So it is 01670101.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you so much. Let me pull that up for you today, Ms. [PII].
[CUSTOMER][NEUTRAL] I'm sorry. There is, there is no one in the now my brain got.
[AGENT][NEUTRAL] No, that's OK, we'll just both start fresh, it's fine.
[CUSTOMER][NEUTRAL] OK. So it is 016701.
[CUSTOMER][NEUTRAL] 07. My God.
[AGENT][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][POSITIVE] All right, let's get that one pulled up for you, [PII].
[CUSTOMER][POSITIVE] I'm sorry for that.
[AGENT][NEUTRAL] It's OK, it happens.
[CUSTOMER][NEUTRAL] Mhm mhm.
[AGENT][NEUTRAL] Maybe we need to go get some coffee after.
[CUSTOMER][NEUTRAL] Maybe, yes.
[AGENT][NEUTRAL] All right. Let's see one.
[CUSTOMER][POSITIVE] I really appreciate your patience. That's a good thing.
[AGENT][NEUTRAL] Oh no, absolutely.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Likewise.
[CUSTOMER][POSITIVE] Mhm. You tell me she is, it's good.
[AGENT][NEUTRAL] Alright, and would you be able to verify that member's first and last name and date of birth for me, pretty please?
[CUSTOMER][NEUTRAL] Yes, sure. The member's first name is [PII], last name is [PII], and date of birth is [PII].
[AGENT][POSITIVE] Perfect. I do see him here and what is the date of service we wanna look at for [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, sure. It is [PII].
[AGENT][POSITIVE] Perfect. OK, perfect.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, hang tight one second.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You said [PII], right?
[CUSTOMER][NEUTRAL] Yes, correct. [PII].
[AGENT][NEUTRAL] All right, so actually I'm not seeing a claim on file for that data service and let me double triple check um.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh no, I am seeing a claim on file. I'm sorry. I don't know, Ms. [PII]. I'm so sorry. I do see it. One second, let me get that all pulled up for you.
[CUSTOMER][NEUTRAL] No, it's just
[CUSTOMER][POSITIVE] Uh no issues.
[CUSTOMER][NEUTRAL] That is totally fine, Ali, but no wish issue, as you said, we have to go grab some coffee. It's a human thing, right? No issue.
[AGENT][NEUTRAL] I think so.
[AGENT][NEUTRAL] And what was the total full amount on that claim we wanted to look at today?
[CUSTOMER][NEUTRAL] It's $51 even?
[AGENT][POSITIVE] 51 even. OK, perfect.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 66
[CUSTOMER][NEUTRAL] OK, because you mentioned 77.
[AGENT][NEUTRAL] Alright, so I see that claim here. It looks like we received your claim on [PII]. We have your claim number is 341-7966, and we processed that claim on [PII].
[CUSTOMER][NEUTRAL] I do, I
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, Mercy Clinic, and I do see that that claim was also denied. I have the reason stating that these services were rendered after coverage was terminated, and I do show here that for [PII], um, that this coverage lapsed on [PII].
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. I'm sorry, what was the date again it was?
[AGENT][NEUTRAL] [PII] is when his coverage lapsed with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII] or [PII], I think maybe my brain good crunch.
[AGENT][NEUTRAL] We're both there. It is uh [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] [PII] great. finally got it. So that is now the uh coverages active for the data service, right?
[AGENT][NEUTRAL] Yeah, so the coverage was no longer active by the date of service and I did check he didn't have any other coverage with us after that policy ended.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. OK, great. Thank you so much. And for uh this claim also, I would like to request you to fax this AOB.
[AGENT][POSITIVE] Perfect. Let me get that pulled up for you, Ms. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much, [PII].
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And how is your day going, Ali, as of now?
[AGENT][MIXED] Oh, it's going really good. Um, I, uh, I'm on my 2nd cup of coffee, but clearly it's not helping. So I'm gonna drink it maybe move to a 3rd.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] But it's sunny here. Like, are you having nice weather where you are?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Good.
[CUSTOMER][NEGATIVE] In here, yes, it's not pretty good in here.
[AGENT][NEGATIVE] It was really cold for a little bit and I didn't like that.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Yeah, but I come back to the sunny we can just chill in the winter, right.
[AGENT][NEUTRAL] Uh, yeah, I guess I don't, I don't know. I guess.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm
[AGENT][POSITIVE] It's like I, I don't like it when it's cold and I don't like it when it's hot, so I just really like this weather right here is perfect. Yeah, exactly.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, oh, normal moderate weather, right?
[CUSTOMER][POSITIVE] OK. Oh, yeah. That is pretty good too.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Alright, 341-796-6 perfect and I am hitting send on this fax right now it should be coming your way.
[CUSTOMER][POSITIVE] OK, thank you so much for that. I think I have got enough information from you for today's call and thank you so much for that and have a great day and take care of yourself.
[AGENT][POSITIVE] Absolutely.
[AGENT][POSITIVE] My pleasure thank you so much, Ms. [PII], and you have a wonderful day. Thanks for calling APL enjoy your weekend.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you. You too. Enjoy your weekend. A total of for good. Tomorrow is the weekend.
[AGENT][POSITIVE] Yep, woo woo. All right. Take care friend. Bye bye.
[CUSTOMER][NEUTRAL] Yes, bye bye.