AccountId: 011433970860
ContactId: eeb536ed-280b-40cd-843c-1053b1a32b3f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 263500 ms
Total Talk Time (AGENT): 128345 ms
Total Talk Time (CUSTOMER): 75074 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/eeb536ed-280b-40cd-843c-1053b1a32b3f_20250203T19:31_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]. I'm calling to check my status.
[AGENT][NEUTRAL] Did you say that your name is [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, ma'am. Uh, and did you say you're needing, we have, there's a terrible echo on this call. Did you say you were needing claim status?
[CUSTOMER][NEUTRAL] Claims
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] 02544110
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. [PII], what is your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] And what is the date of service and total bill for her place?
[CUSTOMER][NEUTRAL] [PII] for $826.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and I just want to re-verify, you did say 10-8 of 2024. Is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I do not have a claim on file for Ms. [PII] for that data service.
[CUSTOMER][NEUTRAL] OK, can I, can you verify the claims address just to make sure that we have.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, ma'am. Go, you can go ahead.
[CUSTOMER][NEUTRAL] Um, we have a [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, yeah, [PII], um, question, can, um, the claims be faxed or not? They have to be mailed.
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[AGENT][NEUTRAL] They can, and you will also need to include the primary insurance company's explanation of benefits as well, but they both can be faxed to [PII].
[AGENT][NEUTRAL] 942-3 attention claims.
[CUSTOMER][NEUTRAL] OK, so you're saying that there's a primary cause I see she has, we have two other insurances. I wasn't sure what type of policy this is.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, sir. I'm sorry, yes, sir. Yes, ma'am. That is correct. She, this, we are not a major medical insurance carrier. This is only a supplemental policy. This is like a gap. So it helps with the co-pays, deductibles, and co-insurance amounts of covered services, [PII]. So that's why we have to have the primary EOB along with the claim for review.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] OK, all right, makes sense. OK, thank you, [PII].
[AGENT][NEUTRAL] Now, yeah, and one last thing, once we have received a claim and it's been processed by us, we do have a portal which you can self register at to have access to the EOBs.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And to check claim status, is that secure. yeah, [PII]?
[CUSTOMER][NEUTRAL] Yeah, I think I'm on it now. Mhm.
[CUSTOMER][NEUTRAL] Yeah,
[AGENT][POSITIVE] OK, yes ma'am. All right. Well, you are certainly welcome. So that's all I can help you with. Thank you for calling APLI. I hope you have a great afternoon.
[CUSTOMER][POSITIVE] OK, thank you again.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.