AccountId: 011433970860
ContactId: f0c842ae-1f20-4804-ab02-c699c19adcc7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 980260 ms
Total Talk Time (AGENT): 241676 ms
Total Talk Time (CUSTOMER): 237656 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/f0c842ae-1f20-4804-ab02-c699c19adcc7_20250527T17:30_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] Hello, this is [PII], calling on behalf of the provider.
[CUSTOMER][NEUTRAL] To check on the claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII]. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] 2
[AGENT][NEUTRAL] OK, and may I have a good contact number in case we're disconnected and the first member's uh policy number?
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, the member's policy number is 1192701.
[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] Yeah, the member's name is [PII] and the date of birth would be [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is the verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Yeah, the bill uh bill amount is December sorry, date of service is [PII]. A bill amount of $348 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] For this, uh, the thing, I, I'm having the claim, uh, details. It got denied. Just I need the UB need to be faxed.
[AGENT][NEUTRAL] OK, let me, um, locate the claim first. Hold on one second.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, hold on, so this is a different.
[AGENT][NEUTRAL] Alright, so the claim number or the policy number that you provided was was not active on the data service. That policy was active from [PII].
[AGENT][NEUTRAL] To [PII].
[AGENT][NEUTRAL] There is an active policy, um, policy number 1569875, that's active and has been active since [PII]. So I'm gonna look and see if the claim is under the active policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, and I've located the claim and um can you verify the name of the provider's office on the claim, I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] One second, the claim on uh Castro Health.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] So I'm showing the claim was received on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim number is 357.
[AGENT][NEUTRAL] 5261.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So number is not having any other insurance, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Is my is having any other policy?
[AGENT][NEUTRAL] Um, not with APL.
[CUSTOMER][NEUTRAL] Any other policy for the rate of service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And uh could you please uh send the to the fax number?
[AGENT][NEUTRAL] Yes, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Yeah, it would be [PII].
[AGENT][NEUTRAL] Attention, [PII].
[CUSTOMER][NEUTRAL] Uh, yeah, you're right, [PII]. And could you please spell your name for me?
[AGENT][NEUTRAL] And that was 6 months
[AGENT][NEUTRAL] Hold on one second. For the fax number, it was 615-77.
[AGENT][NEUTRAL] I missed the number.
[CUSTOMER][NEUTRAL] No, no, no. 1 more 73 consecutive 7, 3536.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So that's the number I was missing, 7. OK, [PII]?
[CUSTOMER][POSITIVE] You are right.
[AGENT][NEUTRAL] OK, so I'll go ahead and fax that over. And for the call reference number for the entire call, it's going to be my name in today's date. And again, that's [PII] initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the next member's policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Yeah, one second. You have sent the UB to the fax number.
[AGENT][NEUTRAL] I'll be sending it at the end of the call. Will you need the EOB with both of them?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, one second, I'm checking that.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] No. OK, fine. um.
[CUSTOMER][POSITIVE] Yeah, I'm ready with the uh policy number.
[CUSTOMER][NEUTRAL] One second, it did not get open. Just give a moment. Yeah, the number is 98.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh sorry, it is a USC then white. Just give me a moment. I'm cross checking one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 00.
[CUSTOMER][NEUTRAL] Yeah, the member ID here, I can see 25921.
[AGENT][NEUTRAL] 25921.
[CUSTOMER][POSITIVE] You are right.
[AGENT][NEUTRAL] That may be the group number. Hold on one moment.
[AGENT][NEUTRAL] What's the member's first and last name?
[CUSTOMER][NEUTRAL] So the [PII]'s first name [PII], and the last name is [PII] it is [PII], again, [PII]. That is the last name.
[AGENT][NEUTRAL] Do you have a copy of the member's ID card available?
[CUSTOMER][NEUTRAL] Uh, one second.
[CUSTOMER][NEUTRAL] I'm checking.
[CUSTOMER][NEUTRAL] Just give a moment, cutting open.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] Oh my [PII].
[AGENT][NEUTRAL] I'm also gonna um search the policy with the member's first and last name. Do you have their full social available?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Uh, one second. So.
[CUSTOMER][NEUTRAL] I need to check with that. Uh, just a moment. I'm checking the ID card. Just give me one moment, OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I could not find the member ID. Yeah, I got one more.
[AGENT][NEUTRAL] What's the member's date of birth?
[CUSTOMER][NEUTRAL] I think there's one.
[CUSTOMER][NEUTRAL] Yeah, the number's date of birth would be uh [PII].
[AGENT][NEUTRAL] All right, and
[CUSTOMER][NEUTRAL] Yeah, I got the uh
[CUSTOMER][NEUTRAL] You have said whatever you have said is that is the right one. It is a group number it's showing in the uh card.
[AGENT][NEUTRAL] You said it's the same group number showing?
[CUSTOMER][NEUTRAL] Uh yes, 25921.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] So let's do this. Do you mind if I place you on just a brief hold? Um, I have the date of birth. We only have a [PII] [PII]'s, so I'll go through it um because it's 259, you said 25921, right, for the group?
[CUSTOMER][POSITIVE] Yes, yes, yes.
[AGENT][NEUTRAL] Yeah, it's, that's pulling up um there's no member with that name under the group. Um, so hold on one moment and I'll go through what I have here and see if I can locate the policy for you, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, hello, [PII].
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait. So I went through all of the policies that we have here with the name of [PII], but they all have a different date of birth than your member, um, so we don't have a member on file for you.
[CUSTOMER][NEUTRAL] OK. You're saying the number is not on file.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Or else claim is not on file.
[AGENT][NEUTRAL] Right, so we would need more information if you can provide an APL policy number, um, their full social, um, but I searched all the policies with the name and none of the dates of birth match.
[CUSTOMER][NEUTRAL] OK, just came out, man.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Lovely.
[CUSTOMER][NEUTRAL] I do want that the uh just the number for the claim, for the number, sorry. Uh.
[CUSTOMER][NEUTRAL] So whatever the date of birth, it's not matching uh with the member's name.
[AGENT][NEUTRAL] Right, the date of birth is [PII] does not match any of the um [PII]'s that we have here on file.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] There is no date of birth in April that matches the member. It, it's the one that we have on file is a different date of birth. It's a different month, a different
[CUSTOMER][NEUTRAL] Date of birth?
[AGENT][NEUTRAL] He's not on file, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, fine. Got it. Thank you. Thank you so much and you please send the uh to the first claim to the same fax number.
[AGENT][POSITIVE] Yes, that you'll be has been sent. You should be receiving that shortly. I just sent that for you as well.
[CUSTOMER][POSITIVE] OK. Uh thank you so much and have a great day.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, thank you so much.
[AGENT][POSITIVE] You're welcome. Well, thanks for calling APL and I hope you have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you