AccountId: 011433970860
ContactId: fcb95904-93d5-42fa-bbb4-2123b5273b89
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 588500 ms
Total Talk Time (AGENT): 246926 ms
Total Talk Time (CUSTOMER): 188905 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/fcb95904-93d5-42fa-bbb4-2123b5273b89_20250527T13:58_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. My name is [PII]. Last initial is [PII], and I'm calling from provider's office to check on a claim status.
[AGENT][POSITIVE] OK, I'm so sorry. Could you spell your first name for me, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK [PII], and you're wanting to check claim status for one member, is that correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Yes, I can help you with that, [PII], and what is your callback number?
[CUSTOMER][NEUTRAL] Uh, give me a second.
[CUSTOMER][NEUTRAL] Um, my callback number is [PII]. And uh can you please spell your good name?
[AGENT][NEUTRAL] OK, let's do your phone number one more time please, [PII].
[CUSTOMER][NEUTRAL] Sure, no issue. Sure. It is [PII].
[AGENT][NEUTRAL] What is the extension again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so that was [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, which is 02301155 M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] OK, thank you. One moment, [PII] while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] Sure. Can you please spell your good name for me, [PII]?
[AGENT][NEUTRAL] It is [PII]
[CUSTOMER][NEUTRAL] Initial of your last name, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Got it. Thank you so much for that.
[AGENT][NEUTRAL] You're welcome. And any information [PII] that I provide 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] Patient name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what is the date of service and total bill amount for him please [PII]?
[CUSTOMER][NEUTRAL] Sure. The date of service is [PII]. The amount of $53,304.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, as of now, [PII], we have not received a claim from the provider for this data service and that billed amount for again the date of service is 34-25, is that correct?
[CUSTOMER][NEUTRAL] Sure, OK.
[CUSTOMER][NEUTRAL] Correct. That's the right one. And uh like uh [PII], can you please validate the address like from my end of the mailing address is [PII].
[AGENT][NEUTRAL] Mm, no, sir.
[AGENT][NEUTRAL] No, sir, for the supplemental policy? No, sir. I don't even know what that address is.
[CUSTOMER][NEUTRAL] That's not.
[AGENT][NEUTRAL] But for this policy.
[CUSTOMER][NEUTRAL] So, can you please help me with the correct address?
[AGENT][NEUTRAL] Mhm. The correct mailing address for claims is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] And because this is a supplemental policy to the primary insurance, [PII], when the claim is submitted to APL, we will have to have a copy of the primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed the claim here we do have a portal that you should be able to check our claim status in and that website for our portal is located at [PII].
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] So, uh that, do I need to have uh access?
[AGENT][NEUTRAL] You, it's a self registering portal you would go to that website and then start with I am a provider and complete the um information that it asked for and again that's for claim status.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Sure, but uh is it possible for you like if you can uh guide me through like the, to the link where I can do self-register?
[AGENT][POSITIVE] Yes sir I gave you the link secured.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Uh, under that APL secure, uh, uh, that's fun, right?
[AGENT][NEUTRAL] It should say online service center if you typed in [PII], it should pull up online service center.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, I got it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And if you would like to wait until after tomorrow to set up that profile, [PII], because there are some changes uh coming tomorrow.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Which you should have seen that message. It does give you that message on the screen.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] His new online service center coming [PII].
[CUSTOMER][POSITIVE] Sure, no issues. And uh
[CUSTOMER][NEUTRAL] Uh, I got it. And can you please
[AGENT][NEUTRAL] And again, you can't check eligibility.
[CUSTOMER][NEUTRAL] Yeah, I just require the eligibility of this patient.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] I'm just stating that you cannot.
[CUSTOMER][NEUTRAL] Can you please help me with that?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, sir. Again, you can't check eligibility, and I just gave you claim status. The portal is for claim status.
[CUSTOMER][NEUTRAL] Uh, the portal is still loading.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So was there anything else on this claim status that I could help you with today?
[CUSTOMER][NEUTRAL] I just, uh, I just need only like the eligibility of this patient to resubmit the claim, but in the portal, it's still loading, so that's the reason I'm just requesting if you can have uh access, you can give me.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] [PII], yes sir, [PII], I said that you cannot check eligibility in the portal. You can only check claim status if we have processed the claim.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But this member's policy.
[CUSTOMER][NEUTRAL] Until and unless, how can we come?
[CUSTOMER][NEUTRAL] Uh-huh. Go ahead.
[AGENT][NEUTRAL] This member's policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And still active, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And in portal, with the, just the claim status, we will get it, right? Not an eligibility.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Got it. No, I got it. And do you have any payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][POSITIVE] Got it. I'll just resubmit it to the mailing address. And I'm done for the call. Thank you so much, uh, [PII] for assisting me. Can you please help me with the call reference number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][POSITIVE] Oh, got it. Thank you so much, [PII]. I'm done for the call.
[AGENT][POSITIVE] Well, you're very welcome. And if that is all that I can help you with, thank you so much for calling APL today, [PII], and I hope you have a very nice day.
[CUSTOMER][POSITIVE] Thank you. You too. Bye for now.
[AGENT][POSITIVE] Yes, sir. Thank you. Bye bye.