AccountId: 011433970860
ContactId: e6a347e5-90f7-45ef-a8df-02b58e64a31b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 624940 ms
Total Talk Time (AGENT): 185734 ms
Total Talk Time (CUSTOMER): 171481 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/e6a347e5-90f7-45ef-a8df-02b58e64a31b_20250210T20:14_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. My name is [PII]. I'm calling from the provider's office to check on a claim status.
[AGENT][POSITIVE] OK, well I'll be more than happy to help you with the claim status, [PII] and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it would be [PII] and the extension would be, give me one second, it's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the um policy number for the member?
[CUSTOMER][NEUTRAL] Yes, it's 01622990. M as in Mike, L as in Lima, the number 8.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And [PII], how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Just 2.
[AGENT][NEUTRAL] OK, can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, first name is [PII]. Last name is [PII], and the date of birth would be on.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the um data service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Yes, it would be on [PII]. Bill amount would be $237.
[AGENT][NEUTRAL] OK, so there's actually an active policy. Um, so your, the policy number that you provided, 1,622,990 was active from [PII].
[AGENT][NEUTRAL] The active policy
[CUSTOMER][NEUTRAL] Uh, uh, the
[CUSTOMER][NEUTRAL] Could you like verify the policy number once more? It's 016229.
[CUSTOMER][NEUTRAL] 90 Mike Lima and number 8.
[AGENT][NEUTRAL] So that policy again was active from [PII]. There is an active policy number.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] The policy number is 1,755,280.
[AGENT][NEUTRAL] And it's been active since [PII], so I'm gonna check under the active policy to see if there is a claim there.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yes, it's Gastro Health LLC.
[AGENT][NEUTRAL] Alright, so I shall receive the claim.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] The claim number is 352.
[AGENT][NEUTRAL] 4294.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because office visits are not covered on this policy?
[CUSTOMER][NEUTRAL] Of.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] So, OK, ma'am. That would be it for this one. What would be the color for for this?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, and the first initial to my last name is [PII]. My first name is [PII]
[CUSTOMER][NEUTRAL] OK, thank you for that, [PII]. And yes, that would be it for this one. So I'll go ahead and provide you with the next member's ID?
[AGENT][NEUTRAL] Um, hold on one moment, let me note this policy.
[AGENT][NEUTRAL] OK, the next member's policy number?
[CUSTOMER][NEUTRAL] Yes, it would be
[CUSTOMER][NEUTRAL] 019.
[CUSTOMER][NEUTRAL] 89414 Mike Lima and number 7.
[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] Yes, member's first name is
[CUSTOMER][NEUTRAL] [PII], last name is [PII], and the date of birth would be on [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 for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Yes, it would be on [PII]. Bill amount would be $3,045 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So I'm actually not showing a claim on file for [PII] for [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, I do have a claim number with me. Let no, let me, yes, I do have a claim number with me. Can you please verify with that?
[AGENT][NEUTRAL] Sure, what's, um, what's that claim number?
[CUSTOMER][NEUTRAL] It would be 349-9515.
[AGENT][NEUTRAL] OK, I see what's happening again. This one.
[CUSTOMER][NEUTRAL] OK. Uh, this one was for at
[AGENT][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yes, this one was for a different NPI.
[AGENT][NEUTRAL] It's not the NPI it's the policy number. So this was processed under policy number 2462857. Hold on one moment, let me pull that up and locate the claim. And you have the claim number. Did you have a particular question about the claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh yes, for this one we requested an EOB, but we didn't receive it because uh that's why I'm calling to request another EOB for this one.
[AGENT][NEUTRAL] OK, you need the explanation of benefits for this one faxed to you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what's a good fax number for you?
[CUSTOMER][NEUTRAL] It would be [PII].
[AGENT][NEUTRAL] And does that need to be attention, [PII]?
[CUSTOMER][NEUTRAL] Uh yes, ma'am. And could you like,
[AGENT][NEUTRAL] And that was 6
[CUSTOMER][POSITIVE] Yes, please go on.
[AGENT][NEUTRAL] That was [PII]?
[CUSTOMER][NEUTRAL] Uh yes, ma'am.
[AGENT][NEUTRAL] OK, and what questions did you have?
[CUSTOMER][NEUTRAL] Uh, yes, could you like fax the EOB for the previous claim to from, for this one?
[AGENT][NEUTRAL] Sure, hold on one moment.
[AGENT][NEUTRAL] And they're both going to that same fax number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hold on one moment, OK?
[CUSTOMER][POSITIVE] OK, take your time, no problem.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh, [PII]?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So I have faxed you over um both um explanation of benefits.
[CUSTOMER][POSITIVE] Yes, ma'am, thank you for that. And yes, that would be it, ma'am. And thanks for your assistance and I hope you have a great day ahead. Bye-bye.
[AGENT][POSITIVE] Thank you, thank you also, and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.