AccountId: 011433970860
ContactId: e87afb2d-c0d5-48f9-8ac3-106756ad1076
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 255580 ms
Total Talk Time (AGENT): 101626 ms
Total Talk Time (CUSTOMER): 90601 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/e87afb2d-c0d5-48f9-8ac3-106756ad1076_20250506T17:40_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I was calling to find out claim status for a patient.
[AGENT][NEUTRAL] OK, I can help you. What's your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And [PII], what's the policy number?
[CUSTOMER][NEUTRAL] It is 01984214.
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you for that and what's the date of service of the claim?
[CUSTOMER][NEUTRAL] It is for.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the total charge?
[CUSTOMER][NEUTRAL] Uh, was for $282.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Set for an office visit and [PII]. OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] So the office visit and then the treatment code is not covered under the patient's policy, so there was no payment made. It looks like we received it twice the second time it was denied as a duplicate. Do you want the original claim number or both?
[CUSTOMER][NEUTRAL] Uh, I don't need the claim number. We just never received it, so I need to know how it processed, so I'll put it to patient you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, and the explanation
[AGENT][NEUTRAL] Yeah, the patient, the explanation of benefits was mailed to the billing address on your claim.
[AGENT][NEUTRAL] Uh, each time. Mhm.
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEGATIVE] We never received it. That's weird, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Well, I will put it to patient too. Thank you.
[AGENT][NEUTRAL] Alrighty, any other questions, [PII]?
[CUSTOMER][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] OK, and you can also check claim status and download the EOB from the the website if you would like as well if you, if you, you know, do need a copy of it.
[CUSTOMER][NEGATIVE] Yeah, I tried to do that as well and it said the member wasn't found.
[AGENT][NEUTRAL] So her policy is no longer active, but that was as of, um, let's see.
[CUSTOMER][NEUTRAL] I put our um
[AGENT][NEUTRAL] And that was as of recent.
[AGENT][NEUTRAL] Um, did it ask you for the provider tax identification number and patient account number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what information did you put in those fields?
[CUSTOMER][NEUTRAL] I put our tax ID number and then I put the patient's ID.
[AGENT][NEUTRAL] Mhm. Can you verify each of those?
[CUSTOMER][NEUTRAL] The [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Um, the patient ID is [PII].
[CUSTOMER][NEUTRAL] And then our tax ID is [PII]?
[AGENT][NEUTRAL] Mhm. The patient account number is on your claim on page 20 on uh section 26 of the CMS 1500 form, so not our policy number, it's the patient account number that's assigned by the office, doctor's office.
[CUSTOMER][NEUTRAL] Oh, well that would be a voucher number. OK, I didn't know that.
[AGENT][NEUTRAL] Mhm. Yeah, that.
[CUSTOMER][NEUTRAL] I just thought it would be the ID because.
[AGENT][NEUTRAL] Yeah, I think online it says if it's a CMS looking box number 26 for that number.
[AGENT][NEUTRAL] For the patient.
[CUSTOMER][NEUTRAL] OK, well I don't have a claim form to know that what that would have been.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I'm just working off of a report, not a claim form, so, but thank you for the information.
[AGENT][NEUTRAL] OK. All right.
[AGENT][POSITIVE] Oh, you're welcome. Anything else?
[CUSTOMER][NEUTRAL] Nope, that'll be all.
[AGENT][POSITIVE] Alright, [PII], thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye.