AccountId: 011433970860
ContactId: ecca86b8-c3c0-4bcf-b1c6-e69f94e7c2c3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1057359 ms
Total Talk Time (AGENT): 284714 ms
Total Talk Time (CUSTOMER): 283099 ms
Interruptions: 6
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/ecca86b8-c3c0-4bcf-b1c6-e69f94e7c2c3_20250114T13:23_UTC.wav
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[AGENT][POSITIVE] Good Morning, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. The last initial, [PII]. I'm calling from the provider's office to check on the claim status.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct? Yes, I can help you with that. Uh-huh, I can help you. And what is your callback number, please?
[CUSTOMER][NEUTRAL] Yes, yes. Yes, only one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Sure. 02069892.
[AGENT][NEUTRAL] OK thank you one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Patient name is [PII] 90. Date of birth is [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It services
[CUSTOMER][NEUTRAL] [PII], the total amount of $1,105 even.
[AGENT][NEUTRAL] OK. Thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, you said 813 of 2024, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK then let me just look at a couple of things.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, there is no claim on file for her for him or for her for this data service.
[CUSTOMER][NEUTRAL] Yeah, I, I have the claim number.
[AGENT][NEUTRAL] For part 4, I mean for [PII], OK, you can give me the claim number and I'll be happy to check and see who that's for. Mhm but we don't.
[CUSTOMER][NEUTRAL] Very
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes, 353.
[CUSTOMER][NEUTRAL] 353-227-4.
[AGENT][NEUTRAL] OK, let me look that claim number up because that is not for this child for this data service.
[CUSTOMER][NEUTRAL] It's on [PII], 2024 with the bill amount of, yeah, $1,105.
[AGENT][POSITIVE] Oh, that is correct.
[CUSTOMER][NEUTRAL] 1105.
[AGENT][NEUTRAL] OK, that is not.
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] OK, just one moment. OK, give me one moment, please. Let me refresh something.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] This is the uh
[CUSTOMER][NEUTRAL] Medicare supplement plan.
[AGENT][NEUTRAL] Yes sir, but I'm trying to see why it's not pulling up this claim for me one moment, OK, [PII]?
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] What did you say this is for a child, is that correct?
[CUSTOMER][NEUTRAL] Yes. No, the patient data what this.
[AGENT][NEUTRAL] OK, so this claim.
[CUSTOMER][NEUTRAL] Patient date of birth is [PII].
[AGENT][POSITIVE] OK. I'm very sorry. I was looking, there's a dependent child by the same name, so I'm so sorry. Give me just a moment.
[CUSTOMER][NEUTRAL] Mhm. The patient name is [PII].
[AGENT][NEUTRAL] Yes, sir. And there is also a dependent child on the same, on the policy with the same name.
[CUSTOMER][NEUTRAL] [PII] Yeah.
[AGENT][NEUTRAL] And I misunderstood the date of birth, so just one moment. Uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, fine. Fine. I understood. OK, fine. [PII]. No problem with that.
[AGENT][NEUTRAL] OK, so I didn't realize you already have the claim number, so how can I help you on this claim?
[CUSTOMER][NEUTRAL] Yeah. Uh, what about the claim status for this one?
[AGENT][NEGATIVE] It's denied.
[AGENT][NEGATIVE] Office visits are not covered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] By the above numbered policy.
[CUSTOMER][NEUTRAL] OK. What about the
[AGENT][NEUTRAL] And then on the other codes, all payable benefits were applied to the policy deductible.
[CUSTOMER][NEUTRAL] Mhm. What about the
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. How much it operates towards?
[AGENT][NEUTRAL] Are the remark
[AGENT][NEUTRAL] Uh, one there was 6759.
[AGENT][NEUTRAL] That's what was applied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see, give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, was it, yes, that was the total amount applied.
[AGENT][NEUTRAL] There was 28, OK.
[CUSTOMER][NEUTRAL] How much? 6759?
[AGENT][NEUTRAL] Let's see, let me break this down. 28.5 $28.53 was on 73,030 and on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, 1 2nd.
[AGENT][NEUTRAL] Mhm. Sure.
[CUSTOMER][NEUTRAL] For the code [PII], it was $32.83. And uh OK, fine. Uh OK.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] And the uh $228.53. OK, fine, understood. Do you have a copy of PIP because we uh we called previously two times and uh uh faxed the copy of you, but we didn't receive any from your end. So can you please send us?
[AGENT][NEUTRAL] OK, so, so I can, you can print this yourself though, [PII], which I think if we faxed it twice and you've not received it, that you should just print it from our portal.
[CUSTOMER][NEUTRAL] No, we, uh,
[AGENT][NEUTRAL] Our portal website.
[CUSTOMER][NEUTRAL] Oh, we don't have the access to portal, uh, because, so, can you please fax it the last time? I'm waiting on the line. Can you please fax it to me right now? I'm in the fax seat.
[AGENT][NEUTRAL] OK, let
[AGENT][NEUTRAL] Mm. Yes, sir. Give me just a couple.
[CUSTOMER][NEUTRAL] Let me get that.
[AGENT][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Yeah, yeah, sure, sure.
[AGENT][POSITIVE] Mhm, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Maybe
[AGENT][POSITIVE] You can go ahead and give me the fax number. It's gonna take a couple of minutes for this to load for me.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] 369
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the extension to my name, [PII].
[AGENT][NEUTRAL] [PII] is your [PII] your [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yeah, you're right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so I see that this was faxed on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] But we didn't receive any fax from you and
[CUSTOMER][NEUTRAL] Can you please check the number twice?
[AGENT][NEUTRAL] Yes, it is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 369-0040. Is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, right.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] And I'm still waiting for this to load.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Still waiting, [PII]. Just as soon as it comes up, I can fax it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you for your patience.
[CUSTOMER][POSITIVE] Mhm. No problem with that.
[CUSTOMER][NEUTRAL] You said your name is?
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I apologize about the lengthy delay.
[CUSTOMER][POSITIVE] No problem with that. I'm waiting on the line.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So, uh, text, text to.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Text texts to go second.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so I have faxed this to you, [PII], and I did send it to [PII] to your attention. Do you want to remain on the line to verify if it is received?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, can you please wait a couple of minutes or is it OK.
[AGENT][NEUTRAL] OK. We can, mhm, yes, I'll just work on making my notes related to our call. Mhm sure.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, OK. OK.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah, I think the banks are not. OK, fine. Thank you. I'm waiting on the line.
[AGENT][NEUTRAL] Is it, yes. So you do want to wait on the line, correct, to verify that it's received?
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a couple of minutes.
[AGENT][NEUTRAL] Oh, you're, you're fine. It's gonna take a few moments to go through our system.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But it has been faxed.
[CUSTOMER][POSITIVE] Mm thank you.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I I.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I will also, I should receive a notification on my end as well, [PII], that tells me that it has suc.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And sent successfully.
[CUSTOMER][POSITIVE] We, I, yeah, I also received the UP. Thank you so much, uh, yeah, [PII].
[AGENT][NEUTRAL] Uh
[AGENT][POSITIVE] Oh, you do have it? You did receive it? Oh, perfect. OK. OK. Well, is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, I received it. Uh-huh mhm.
[CUSTOMER][POSITIVE] Uh, no, [PII]. Thank you so much for your assistance and have a happy.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Bye. Bye-bye.
[AGENT][POSITIVE] I hope you have a very nice day as well, [PII], and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Mhm. Bye-bye.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.