AccountId: 011433970860
ContactId: ec7a4b9e-e096-4e75-afc5-74fe8269934e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 678729 ms
Total Talk Time (AGENT): 248638 ms
Total Talk Time (CUSTOMER): 244902 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/ec7a4b9e-e096-4e75-afc5-74fe8269934e_20250106T17:14_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from the provider's office to check on a claim status. And before we proceed, I would like to inform you that this call is being recorded for quality and training purposes. Is that OK with you?
[AGENT][NEUTRAL] Yes, that's fine. And for the, for my notes, can you spell your first name for me, please?
[CUSTOMER][NEUTRAL] It is [PII] spelled as [PII]. Initial my last name is [PII].
[AGENT][NEUTRAL] OK, and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] That's [PII]. The policy number is 01741606 M as in Mary L as in Lima 8.
[AGENT][POSITIVE] Thank you for that. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] 3 claims.
[CUSTOMER][NEUTRAL] Ah
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] That's [PII]'s date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII] total bill amount $450 even $450.
[AGENT][NEUTRAL] And all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Um, it does.
[CUSTOMER][NEUTRAL] Ah, the name of the provider, the rendering provider, you mean to say?
[AGENT][NEUTRAL] No, the name of the provider is in the facility.
[CUSTOMER][NEUTRAL] A diagnostic Center for Women.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] I'm sure you received the claim on [PII].
[AGENT][NEUTRAL] That claim number is 3475335.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hold on, hold on, hold on, hold on, go ahead with the claim number now 347.
[AGENT][NEUTRAL] 5335.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied, requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] We have submitted that explanation of benefits on [PII].
[AGENT][NEUTRAL] OK, let me see what this is. Hold on one moment.
[AGENT][NEUTRAL] So on [PII], the claim was received?
[AGENT][NEUTRAL] That claim number is 354.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 1250.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me see when it was processed.
[AGENT][NEUTRAL] On [PII], the claim finished processing and we paid out to the provider $371.38.
[AGENT][NEUTRAL] Did you need the check-in?
[CUSTOMER][NEUTRAL] Via check or EFT? Yes.
[AGENT][NEUTRAL] So it's check number 2018538.
[AGENT][NEUTRAL] It was a single check.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, issued on [PII].
[AGENT][NEUTRAL] And sent to [PII].
[CUSTOMER][NEUTRAL] OK, and what would be the, OK, go ahead, go ahead.
[AGENT][NEUTRAL] So
[AGENT][POSITIVE] If this check has not been received by [PII], you can give us a call and we'll check on the check and reissue. As of right now, it's showing as outstanding.
[CUSTOMER][NEUTRAL] No problem. And before the um before the reference number after this I have 2 more claims to check on. So can you help me with those two claims as well?
[AGENT][NEUTRAL] Is it the same member or different members?
[CUSTOMER][NEUTRAL] Different member but under the same facility.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] The reference number for the entire call will be my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you so much for that one, and can we proceed with the next member ID now?
[AGENT][NEUTRAL] Um, hold on one moment, I have to note the policy.
[CUSTOMER][POSITIVE] No problem, take your time.
[CUSTOMER][NEUTRAL] I be.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][POSITIVE] I see where you got the right I got that.
[CUSTOMER][NEUTRAL] On my way down.
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] OK. What's the next member's policy number?
[CUSTOMER][NEUTRAL] 02260491 M as in Mary, L as in Lima number 8.
[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] My name is [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] What's going on?
[AGENT][NEUTRAL] Thank you for that. And all the information again provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and total bills?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII] total bill amount $450 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 67.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] That.
[CUSTOMER][NEUTRAL] Ah.
[AGENT][NEUTRAL] On the insurance submitted. OK, so I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] That claim number is 35 I'm sorry, 345.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hold on, hold on, hold on. And that was also denied for primary UOB, so we have submitted a copy of primary it will be on [PII].
[CUSTOMER][NEUTRAL] I didn't do it in a way. I
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] So, the claim was received on [PII]?
[AGENT][NEUTRAL] The claim number is 354.
[AGENT][NEUTRAL] 1340.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] And on [PII], we paid out to the provider $200.56.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] You want
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Check number.
[AGENT][NEUTRAL] Let me get that information for you. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Check number is 2018533.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And where was this check might be able to?
[AGENT][NEUTRAL] Um, the information, hold on, let me go back to that screen. It's the same as the other provider. Um, hold on one moment. It's the same provider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Diagnostic Center for Women, [PII].
[CUSTOMER][POSITIVE] OK, no problem. Can you proceed with the next one by now?
[AGENT][NEUTRAL] Um, may I have to know each policy. Hold on one moment.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][NEUTRAL] So and that.
[AGENT][NEUTRAL] OK, and the last member's policy number?
[CUSTOMER][NEUTRAL] 02337144 M as in Mary, L as in Lima number 8.
[AGENT][NEUTRAL] And the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] That's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. May I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] Uh, [PII] total bill amount $405 even $405. And for this one also, [PII], uh, we have submitted a copy of primary U be on [PII].
[AGENT][NEUTRAL] Um, so there is, let me see if this is it.
[AGENT][NEUTRAL] No. So there's a claim that was received on [PII], but it's in processing, so I can't confirm that it is your claim. Um, the only claim that we have right now is the original claim.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So did you receive a primary UB, a copy of primary UB?
[AGENT][NEUTRAL] Let me see
[AGENT][NEUTRAL] Again, we received the claim on [PII], but it's in processing, so all I see is zeros. So I'm trying to see if there's a way I can access this to confirm it's your claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] And that's why I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Just waiting for the document to populate here. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, no, this isn't your claim. This is a different data service, so we haven't received that second claim.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] No problem. So the claim number is the same as the original one?
[AGENT][NEUTRAL] Right, we only have the one original claim, 352-6570.
[CUSTOMER][POSITIVE] No problem. Thank you so much for your assistance and have a great day. Bye-bye, take care.
[AGENT][POSITIVE] Thank you also and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] That