AccountId: 011433970860
ContactId: ed4f90e8-798a-41ba-a164-2143002df3e0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 672599 ms
Total Talk Time (AGENT): 238579 ms
Total Talk Time (CUSTOMER): 169847 ms
Interruptions: 4
Overall Sentiment: AGENT=0.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/ed4f90e8-798a-41ba-a164-2143002df3e0_20250425T17:44_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I need to get some information on claims for a patient.
[AGENT][NEUTRAL] OK, [PII], you're needing to check claim status, is that correct?
[CUSTOMER][POSITIVE] Yes, ma'am. That is correct.
[AGENT][POSITIVE] Yes ma'am, I can help you with that, and [PII], what is a good call back number for you?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] 02456317.
[AGENT][NEUTRAL] OK thank you give me a couple of moments please to get the member's information pulled up.
[CUSTOMER][NEUTRAL] Yes ma'am, I'm calling for his dependent.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Or wife, his wife.
[AGENT][NEUTRAL] And any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] It's [PII], that's her name. Jeez go. Long day.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] And do you have more than one data service, [PII]?
[CUSTOMER][NEUTRAL] I do, yes ma'am, they're all in March though.
[AGENT][NEUTRAL] Or just one?
[CUSTOMER][NEUTRAL] I have 3.
[AGENT][NEUTRAL] OK, and what is the first date of service and total bill amount please?
[CUSTOMER][NEUTRAL] [PII], $584.
[AGENT][NEUTRAL] I'm sorry, $584. Is that correct?
[CUSTOMER][POSITIVE] Yes ma'am, yes ma'am.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so this claim was received. Are you gonna need the receiving process date or just the claim number?
[CUSTOMER][NEUTRAL] So I need to see if um the status more or less if it was paid or denied I need an EOB possibly.
[AGENT][NEUTRAL] And the status.
[AGENT][NEUTRAL] Yes ma'am and you can actually if no one's ever given you our website for our portal Melody, we have a portal that once you have the claim number you should be able to print the each EOB.
[CUSTOMER][NEUTRAL] What is the what is the portal?
[AGENT][POSITIVE] It is secured.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the claim number for this particular claim is 3,586,040.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And we did also mail an explanation of benefits.
[AGENT][NEGATIVE] But this claim was denied.
[AGENT][NEUTRAL] And the reason for the denial?
[AGENT][NEUTRAL] states this policy does not provide benefits for any procedure or service not listed in the schedule of covered services.
[CUSTOMER][NEUTRAL] OK, so that the, the y'all don't cover a 4342.
[AGENT][NEGATIVE] Both of these codes are not covered. It has no benefits for.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Oh OK, so.
[CUSTOMER][NEUTRAL] Is it preventative only?
[AGENT][NEUTRAL] It's preventative and basic. Yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah, OK, so that would make sense. Alright, so that now I can just look here and see why. Alright, can I have the date of that denial?
[AGENT][NEUTRAL] Uh, you can let me get back to that screen.
[AGENT][NEUTRAL] 47
[CUSTOMER][NEUTRAL] OK, um, um, I don't think we have, I don't think we have uh a username for the AP.
[AGENT][NEUTRAL] Yeah, you would just set up your own profile it's a self registering portal.
[CUSTOMER][NEUTRAL] I don't see
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, is there any way that I can get the EOBs either faxed or emailed in the interims or or is that not possible?
[AGENT][NEUTRAL] Uh yes, ma'am. Just give me just a moment and I'll let me pull that up.
[AGENT][NEUTRAL] You can while it's loading, you can go ahead and give me your fax number.
[CUSTOMER][NEUTRAL] It's uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yes ma'am, yes ma'am.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] It's still loading.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Does the fax need to be put to your attention, [PII], or does it, is, is that not necessary?
[CUSTOMER][NEUTRAL] Uh, it'll come to a fact that I have access to. Yeah, it's not really necessary. I'll look for it, yes.
[AGENT][POSITIVE] I got you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm it's still loading.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And again, you said your fax number is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am, that is.
[AGENT][NEUTRAL] All right, so that has been faxed.
[CUSTOMER][POSITIVE] Beautiful. So the next data service is $321 and the submitted amount is set well, to be honest with you, it's probably it's uh $788.
[CUSTOMER][NEUTRAL] Is that who it is?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so this claim was also processed on [PII] and the claim number is 358.
[AGENT][NEUTRAL] 5994.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And at this time the claim is in a holding pattern it has been denied um but the remark that goes along with this states that we are awaiting information to confirm eligibility.
[AGENT][NEUTRAL] For benefits and a card upon receipt of this information, we will continue processing your claim.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, so the fillings, which should be covered, the 2392s are covered under basic. So that one's just still in process basically.
[AGENT][NEUTRAL] Basically, yes ma'am, we're waiting to confirm eligibility for that data service.
[CUSTOMER][NEUTRAL] Do we need to do anything or is that on y'all's end?
[AGENT][NEUTRAL] Uh, that would be something that her employer through her enrollment company provides for us, mhm.
[CUSTOMER][NEUTRAL] OK, oh, OK, perfect. OK, could you tell me about [PII] for the submitted amount of 230 of 223 it's probably the same process of the same situation.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so that one was processed on [PII] and it's under claim number 3589482 and yes ma'am, it does have that same remark regarding eligibility.
[CUSTOMER][NEUTRAL] OK, so it's still in process. OK, so those two are still waiting for the employer to verify. The first one was denied because they're not covered codes. You sent me that EOB. I'm gonna download. That's perfect. Do you have a reference number, Ms. [PII]?
[AGENT][POSITIVE] That is correct. I did.
[AGENT][NEUTRAL] I do. My, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] Is it with an [PII] or [PII]?
[AGENT][POSITIVE] And I. Thank you for asking. Mhm.
[CUSTOMER][POSITIVE] Yes, so I'm a [PII], so I get [PII] all the time, so I try to be respectful of other people's names.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh-huh. I, I pay, I tried to play, play, excuse me, pay close attention when you said that and I understood you to say [PII] So, um, yes, ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Well, [PII], is there anything else I can help? Oh yes, ma'am, you too. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Well I hope that you have a wonderful weekend.
[CUSTOMER][POSITIVE] No, ma'am, that is it. I hope you have a great day.
[AGENT][POSITIVE] OK. Well, I hope you do too, and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Yes ma'am bye.