AccountId: 011433970860
ContactId: e732d859-223a-426e-b9b2-eb1ba2db62ca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 534700 ms
Total Talk Time (AGENT): 165558 ms
Total Talk Time (CUSTOMER): 190835 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/e732d859-223a-426e-b9b2-eb1ba2db62ca_20250115T16:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling AP this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi [PII], my name is [PII]. I'm calling from the provider's office. How are you?
[AGENT][POSITIVE] I'm good. How are you today?
[CUSTOMER][POSITIVE] I'm doing good thanks for asking. Um, I'm calling. I have 5, claims that I am trying to get statuses on that we, you know, in regards to us having to, we have billed them but we haven't received any correspondence back if possible.
[AGENT][POSITIVE] Yeah, absolutely. Um, do you have the policy number?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, um, the first one I have policy number 02.
[CUSTOMER][NEUTRAL] 030120
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull that up here.
[AGENT][NEUTRAL] And if I could get the uh patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, ma'am. [PII].
[CUSTOMER][NEUTRAL] Um, date of birth is [PII].
[AGENT][NEUTRAL] Right. And we're looking for medical claims, yes?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So let me repeat this back. I had 02030120. Is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEGATIVE] OK, because yeah, this doesn't match the information that you gave me. I have a Shannon scheme.
[CUSTOMER][NEUTRAL] Yeah, I'm looking at let's see I got 020301.
[CUSTOMER][NEUTRAL] 20. I'm looking at the card.
[AGENT][NEUTRAL] And the last name is [PII]
[CUSTOMER][NEUTRAL] I got policy.
[CUSTOMER][NEUTRAL] S K
[CUSTOMER][NEUTRAL] [PII], uh-huh. First name is [PII], middle initial is [PII].
[CUSTOMER][NEUTRAL] And it has APL.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Group number 11655
[AGENT][NEUTRAL] Yeah, so I
[AGENT][NEUTRAL] So is the claim for [PII]?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] What's the
[CUSTOMER][NEUTRAL] No, I'm sorry, uh uh, no, ma'am. The, I'm sorry, the claim is for [PII]. I'm sorry about that.
[AGENT][NEUTRAL] Yeah, that's why I'm confused cause I don't show [PII] as a covered insured on this. I have [PII].
[CUSTOMER][NEUTRAL] Oh, she's not covered. Yes, ma'am. OK, so that's probably what it is, yeah.
[AGENT][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEUTRAL] OK, not covered. OK, so that's probably the reason why.
[AGENT][NEUTRAL] Yeah, it just shows that this is like a secondary plan for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then I went back to an older plan and it shows just for [PII] too, so I'm just yeah, not seeing coverage for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got you, so that's just the reason why. OK, that's why on this one,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, we can
[CUSTOMER][NEUTRAL] Um, let me know when you're ready for the next one.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK, um, that policy number is.
[CUSTOMER][NEUTRAL] Hold on, well, you know what? This one, this one, hold on, don't worry about it. This is for the same member. It's a different date of service, so yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So let me, let me go to the next one.
[CUSTOMER][NEUTRAL] This one is um I have 0133.
[CUSTOMER][NEUTRAL] 0870.
[AGENT][POSITIVE] All right, thank you so much. Let me pull this one up.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK. And on this, if I can just get a name and date of birth.
[CUSTOMER][NEUTRAL] Um, patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then on this what is the date of service?
[CUSTOMER][NEUTRAL] The date of service is listed as [PII].
[AGENT][NEUTRAL] OK, and then the buildout.
[CUSTOMER][NEUTRAL] We billed for $422.02.
[AGENT][NEUTRAL] OK, so on this particular claim it looks like um all claims questions on these go through web TPA which is at a different number.
[AGENT][NEUTRAL] Um, I can give you that number and then transfer you at the end of the call if you want to check on this one.
[CUSTOMER][POSITIVE] OK, that'll be great.
[AGENT][NEUTRAL] OK, so the web TPA number is going to be 866.
[AGENT][NEUTRAL] 975.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 9458.
[CUSTOMER][NEUTRAL] 9458.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got you. OK, 96131.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then um,
[AGENT][POSITIVE] I can of course check another one.
[CUSTOMER][POSITIVE] And actually I just have one more left because the other one is for Hayley Skin again so she will be receiving a bill on that one so let's do this.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Last one, the member ID number I have is 100.
[CUSTOMER][NEUTRAL] 7282.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Looks like patient's name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then
[AGENT][NEUTRAL] On this one, what is the data service?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] And then what was the bill amount?
[CUSTOMER][NEUTRAL] Um, we bill for $632.02.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so it looks like on this one we did get the claim for it. It was denied. It's showing services were rendered after coverage was terminated. So it looks like the member's policy lapsed in [PII].
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][POSITIVE] OK. Well, that is pretty much it. If you would like to transfer me to the web TPA, that would be great.
[AGENT][POSITIVE] Absolutely. One moment. I appreciate you calling APL. I hope you have a good rest of your day.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Welcome to TPA.