AccountId: 011433970860
ContactId: fa064154-6d12-406c-b430-919925202f2b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 397549 ms
Total Talk Time (AGENT): 174050 ms
Total Talk Time (CUSTOMER): 115267 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/fa064154-6d12-406c-b430-919925202f2b_20250212T21:32_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, I'm uh calling from a provider's office. I just have a question about the explanation of benefits we received.
[AGENT][NEUTRAL] OK, so you have a question regarding an explanation of benefits from APL is that correct?
[CUSTOMER][NEUTRAL] Yes
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Thank you, and E, what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] 02483963
[AGENT][NEUTRAL] OK, thank you. One moment while I get the member's information pulled up, please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And 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 and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth, [PII].
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, and Ed, what is the data service and total bill amount you're calling about?
[CUSTOMER][NEUTRAL] Data service [PII] total bill amount $270.
[AGENT][NEUTRAL] OK, thank you and if you want to, you can go ahead and give me the claim number also.
[CUSTOMER][NEUTRAL] Claim number 3558565.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] And the name of the provider please?
[CUSTOMER][NEUTRAL] Uh, Doctor [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so yes, [PII], how can I help you with this claim today?
[CUSTOMER][NEUTRAL] Um, it looks like the claim is pending based on a letter that we've gotten, and the remark code says we are awaiting information to confirm eligibility from benefits in a card and I just wanted to get a little bit more information about that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes sir, that is what we are waiting on. Benefits in a card is the enrollment company for this member and we will have to confirm her eligibility for this data service we received our information from them electronically and we have not yet received confirmation.
[AGENT][NEUTRAL] Of that
[CUSTOMER][NEGATIVE] have not yet received confirmation.
[AGENT][NEUTRAL] Yes, we are waiting. Mhm.
[AGENT][NEUTRAL] We're waiting for that information to continue processing the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's something you can only receive from them correct?
[AGENT][POSITIVE] That is correct, yes, sir.
[AGENT][NEUTRAL] [PII], are you still there?
[CUSTOMER][NEUTRAL] Yep, so I'm just writing this down.
[AGENT][NEUTRAL] OK, I'll just like, OK, no, that was fine. I just wanted to make sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um.
[CUSTOMER][POSITIVE] I imagine they have all the best channels for with to uh provide that information.
[AGENT][NEUTRAL] Yes, sir. Again, we received that information electronically from that company.
[CUSTOMER][NEUTRAL] Receive it electronically.
[AGENT][NEUTRAL] Um, uh-huh, but when and once it has been received, once confirmation, then we'll continue processing this claim.
[CUSTOMER][NEUTRAL] Got it, and how long does that take once you receive the information?
[AGENT][NEUTRAL] It's typically 7 to 10 business days.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then mhm and E just for future reference to we also have a portal if you ever need a copy of an explanation of benefits you can set up your profile as a provider by going to secured.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Got it, um, OK, uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I see a phone number there is that something I can just reach out to them and like perhaps put a little pep in their step?
[AGENT][NEUTRAL] I can't answer that. I know it does have their phone number on the.
[AGENT][NEUTRAL] And if they tell you that it has been uh um just from past experience they may tell you that that's been submitted and try to send you back to APL but until it has been electronically processed through our system, the files.
[AGENT][NEUTRAL] There's nothing that we, we can, you know, we can't do anything with that at this point. So they may confirm that they did receive it, you know, and that it's being sent to APL.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] But once we have received it and it, it will get reprocessed or continue processing.
[CUSTOMER][POSITIVE] Got it OK.
[CUSTOMER][NEUTRAL] Alright, uh, is there anything else I need to know for the time being?
[AGENT][NEUTRAL] Mm
[AGENT][NEGATIVE] Uh, no, sir. I don't believe so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, may I have your name one more time, please?
[AGENT][NEUTRAL] Again, my name is [PII] and you would use my name along with today's date ever if you need a call reference number.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII].
[AGENT][POSITIVE] OK. Well, you are certainly very welcome. And again, thank you for calling APL. I hope you have a nice evening.
[CUSTOMER][POSITIVE] Thank you same to you.
[AGENT][POSITIVE] Thank you very much.
[AGENT][NEUTRAL] Bye bye.