AccountId: 011433970860
ContactId: fc085183-56e3-43bc-a427-fb9439842d68
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 397910 ms
Total Talk Time (AGENT): 195793 ms
Total Talk Time (CUSTOMER): 141168 ms
Interruptions: 3
Overall Sentiment: AGENT=1.6, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/fc085183-56e3-43bc-a427-fb9439842d68_20250130T16:09_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. My name is [PII]. I'm calling from provider office to check on a claim status.
[AGENT][NEUTRAL] OK, you have one claim to check status on, is that correct?
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][POSITIVE] Yes, I can help you. And could you spell your name for me?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] Last name initially is [PII].
[AGENT][NEUTRAL] OK. Is there. Thank you. And your callback number, please?
[CUSTOMER][NEUTRAL] [PII] is [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] OK, the member policy number is 01823339 M as in Mike L as in Lima, number 8.
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] And is there 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, please, and their date of birth?
[CUSTOMER][NEUTRAL] Uh, before we proceed, I would like to inform you this call is being recorded for quality and training purpose. The patient name is [PII].
[AGENT][NEUTRAL] That is fine.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Actually, [PII], what is your normal processing date?
[AGENT][NEUTRAL] You're wanting to know if the claim was received and processed, is that correct?
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][NEUTRAL] Yes, I will provide that information to you in a moment. One moment, please.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, and is there again, any information that is provided will be a verification of benefits and not a guarantee of payment. What is the date of service for her place and total bill amount?
[CUSTOMER][NEUTRAL] Date of service I'm looking is [PII] and the total wind amount is $1,031 even 1031.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, now you say there is no claim on file for this member on this policy. This policy was not active for that data service.
[AGENT][NEUTRAL] The effective date on this policy?
[CUSTOMER][NEUTRAL] Claim not on file. Yeah, please.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And this policy has a term date of [PII]. Now she has another policy that is active.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So just one moment please, for me to access that information.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so the correct policy number that you should have for this number is 02506883.
[AGENT][NEUTRAL] And this policy is active, effective [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now give me just a moment to see if we have received the claim.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK. And as of now for date of service, let me reverify this. [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][NEUTRAL] OK, we do not have a claim on file for her for that data service.
[CUSTOMER][NEUTRAL] OK. So you mean to say the policy number which we have uh mentioned and bill the claim is not active. We have to build a, we have to build a fresh claim with the policy which you provided me, 02506883, right?
[AGENT][NEUTRAL] That is correct. We do not have a claim.
[CUSTOMER][NEUTRAL] To American public and, yeah, and there is no claim on file. So let's verify the mailing address.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yeah, so the mailing address we are using, it's [PII].
[AGENT][NEUTRAL] With what you have?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, let me ver OK and what is the PR ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK. So provide me the.
[AGENT][NEUTRAL] And you're there when you just
[AGENT][NEUTRAL] And when this claim is submit, OK, just one moment, I need to give you a couple of more pieces of information. When the claim is submitted to APL for review, you must also send us a copy of her primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Call reference number.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] And then once we have processed our claim, we do have a portal that you should be able to check claim status in and our portal website uh huh, secure. Oh good.
[CUSTOMER][NEUTRAL] Yeah, I use portal. I use portal, but there was.
[CUSTOMER][POSITIVE] There was no claim, so that's why I've called you. So thank you for your assistance.
[AGENT][POSITIVE] That is correct. So you do have that. Well, you're welcome. So, can I help you with anything else?
[CUSTOMER][NEUTRAL] Reference number, please.
[AGENT][NEUTRAL] My name in today's date and my name is.
[AGENT][NEUTRAL] Spelled [PII]
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] [PII]. No, no.
[AGENT][NEUTRAL] No. [PII].
[CUSTOMER][POSITIVE] Thank you so much for correcting me, [PII].
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And today's date, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK. Thank you so much for your assistance. I will be submitting a first claim to you with the correct mailing address and with the correct member ID as well. Thank you so much. Have a great day.
[AGENT][POSITIVE] You're, you're very welcome.
[AGENT][POSITIVE] OK. Yes, sir. And thank you again for calling APO there. I hope you have a nice day as well.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Mm, bye-bye.