AccountId: 011433970860
ContactId: eec41d00-e4c7-4ca9-a83a-6cbc4320192b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 620520 ms
Total Talk Time (AGENT): 191212 ms
Total Talk Time (CUSTOMER): 114318 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/eec41d00-e4c7-4ca9-a83a-6cbc4320192b_20250123T20:01_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, um, good afternoon. My name is [PII] and last term initial on forancy. I'm calling from provider's office regarding claim status.
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] OK, I'll be more than happy to assist you with the claim status, [PII], and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Total 3 claims.
[AGENT][NEUTRAL] 3 claims?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. It is a direct line?
[AGENT][NEUTRAL] Thank you for that. And may I have the first member's policy number?
[CUSTOMER][NEUTRAL] Yeah, just give me a moment. It's loading.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The first member ID is 01741604 M for Mary, L for Lima, 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] OK. The patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the total charge is $5,739 even.
[AGENT][NEUTRAL] I'm sorry, can you repeat that for me, please? It went in and out.
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the total charge, $5,739 even.
[AGENT][NEUTRAL] $5,769 even.
[CUSTOMER][NEUTRAL] 3939.
[AGENT][NEUTRAL] 573 9.00.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And do you mind if I place you on a brief hold while I locate the claim?
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Oh. You are on hold.
[AGENT][NEUTRAL] 28512.
[AGENT][NEUTRAL] 52
[AGENT][NEUTRAL] 6057.
[AGENT][NEUTRAL] 512.
[AGENT][NEUTRAL] Alright so is it do.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. Can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yes, sir. It's Gastro Health LLC.
[AGENT][NEUTRAL] Alright, so I'm showing that the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 352-851-2.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting an um detailed explanation of benefits that shows the amounts applied to the deductible co-pay and co-insurance, and that explanation of benefits has not yet been received for processing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so you need the primary you'll be, right?
[AGENT][NEUTRAL] Right, the primary explanation of benefits that shows the amounts applied to the deductible co-pay or co-insurance.
[CUSTOMER][POSITIVE] OK. Thank you so much. And let's move to another claim.
[AGENT][NEUTRAL] OK, hold on one moment, let me note this claim.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] OK. It's 02518608 M for Mary, L for Lima, 8.
[AGENT][NEUTRAL] 02518608
[CUSTOMER][NEUTRAL] Yeah, 608 M for Mary, L for Lima, 8.
[AGENT][NEUTRAL] All right. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] OK. The date of service is [PII] and the total charge is $1,362 even.
[AGENT][NEUTRAL] $1,362?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] That.
[AGENT][NEUTRAL] 6
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] And can you verify the name of the provider's office on this claim?
[CUSTOMER][NEUTRAL] Gastro.
[AGENT][NEUTRAL] Oh, it's Gastro Health. OK, hold on one moment then.
[AGENT][NEUTRAL] With this one
[AGENT][NEUTRAL] All right, so I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] That claim number is 3552422.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim $297.92.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you need the check information?
[CUSTOMER][NEUTRAL] So the loan amount and pay amount is the same, right?
[AGENT][NEUTRAL] It was we paid the amount that it was charged for, yes, we paid the total charge.
[AGENT][NEUTRAL] We paid $297.92.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, OK, thank you. Can you please provide the payment information?
[AGENT][NEUTRAL] Sure, so with a single check?
[AGENT][NEUTRAL] Check number 202.
[AGENT][NEUTRAL] 3162.
[AGENT][NEUTRAL] It was issued on [PII].
[AGENT][NEUTRAL] [PII] to Gastro Health.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The check is
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] The check is still outstanding. If it is not received by [PII], um, you can give us a call and we'll be more than happy to check on the check and reissue it if needed.
[CUSTOMER][NEUTRAL] Yeah, sure, sure.
[CUSTOMER][NEUTRAL] Thank you. And may I know the call reference number, [PII]?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Can you spell your name?
[AGENT][NEUTRAL] Sure, my name is [PII]
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you for giving this information. Have a nice day.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.