AccountId: 011433970860
ContactId: fd851434-9e02-474b-8c90-27abcfee556b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 620690 ms
Total Talk Time (AGENT): 165896 ms
Total Talk Time (CUSTOMER): 185561 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/fd851434-9e02-474b-8c90-27abcfee556b_20250514T14:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. Um, I'm calling to um verify this patient was eligible during the time of service.
[AGENT][POSITIVE] Sure, I can help you with eligibility.
[AGENT][NEUTRAL] Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Policy number is 02557753.
[AGENT][NEUTRAL] Alright, one moment while I look that up for you.
[AGENT][NEUTRAL] And can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is um last name is [PII] and first name is [PII].
[AGENT][NEUTRAL] And the birthday?
[CUSTOMER][NEUTRAL] It's June.
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] I am showing that this policy is active with an effective date.
[AGENT][NEUTRAL] Of [PII].
[AGENT][NEUTRAL] And is there anything else I can help you with?
[CUSTOMER][NEUTRAL] And to to current?
[AGENT][NEUTRAL] It is current.
[CUSTOMER][NEUTRAL] OK. And um what is the uh mailing address?
[CUSTOMER][NEUTRAL] For this claim, to some medical claims.
[AGENT][NEUTRAL] To submit a claim, it's.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Excuse me, [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] In [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Or you can set up set up an account on our uh service center at [PII] and you can do it all online and you can check claim status as well.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Yeah, because I, mm, OK. We just submit it to that address.
[CUSTOMER][NEUTRAL] Let me double check.
[AGENT][NEUTRAL] Are you looking for a particular claim?
[CUSTOMER][NEUTRAL] Yes, but I just wanna make sure that patient was eligible with this um service, but yeah, we submitted the claim on [PII]. Can you check if you have this claim on file?
[AGENT][NEUTRAL] Do you have the claim number or I can look it up by date of service?
[CUSTOMER][NEUTRAL] Uh, data service will be fine because I don't have a claim number.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] OK, and what was the date of service?
[CUSTOMER][NEUTRAL] Uh, the data service is, um,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] What was the total charge?
[CUSTOMER][NEUTRAL] It was for 1,719.
[AGENT][NEUTRAL] 719.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number if you need it, is 35.
[AGENT][NEUTRAL] 852-220.
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] What was your name again?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Oh I'm telling that.
[AGENT][NEUTRAL] And it looks like we received this on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Let me double check something real quick.
[CUSTOMER][NEUTRAL] Yeah, because, um.
[CUSTOMER][NEUTRAL] We did build it to.
[CUSTOMER][NEUTRAL] Primary insurance, which is 90 degree.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, and
[CUSTOMER][NEUTRAL] They paid and applied to patient 1644.
[CUSTOMER][NEUTRAL] 1 2nd.
[AGENT][NEUTRAL] And you said the date of service was, I'm sorry, [PII]?
[CUSTOMER][NEUTRAL] One second.
[AGENT][NEUTRAL] To [PII], correct? OK.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, it's showing that we did pay that?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK, I'm I'm reviewing this.
[AGENT][NEUTRAL] Let me double check.
[CUSTOMER][NEUTRAL] 00, OK.
[AGENT][NEUTRAL] It looks like we paid, let me double check for you real quick.
[AGENT][NEUTRAL] OK, it looks like we paid $75 towards that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] With that check, the maximum benefit payable for that date of service was met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So what happened here?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] It's like something, it doesn't sound right.
[CUSTOMER][NEUTRAL] Uh, do you show as patient being, um,
[CUSTOMER][NEUTRAL] As you guys being as primary or secondary?
[AGENT][NEUTRAL] We would be a secondary insurance.
[AGENT][NEUTRAL] This is a hospital indemnity plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, because I'm, I'm trying to look for the primary EOB.
[AGENT][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Cause um it, it's just confusing because right now as you were telling me that you guys paid, I was looking at the patients, um.
[CUSTOMER][NEUTRAL] History.
[CUSTOMER][NEUTRAL] And see if we received that payment and I show.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Do you have the provider's office number or name?
[CUSTOMER][NEUTRAL] Uh, yes, it's McCloud.
[CUSTOMER][NEUTRAL] Um, medical.
[CUSTOMER][NEUTRAL] Seos Lares.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Yes ma'am, I am looking it up and it does say that we paid $75 to the provider.
[AGENT][NEUTRAL] Is there anything I can help you with?
[CUSTOMER][NEUTRAL] I don't see the
[CUSTOMER][POSITIVE] No, no, that will be it. Thank you so much for helping.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, giving me this information to just
[AGENT][NEUTRAL] Right, there's nothing
[CUSTOMER][POSITIVE] Yeah, OK, thank you.
[AGENT][NEUTRAL] And like I said, if you want, you can set up uh an account on our online portal at [PII] and you'll be able to uh see all of the claims and claim statuses and see if they were paid or denied and what the reason was for that so that might be helpful as well.
[CUSTOMER][POSITIVE] Yeah, OK. Thank you.
[AGENT][POSITIVE] Great, thank you for calling APL and have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] OK bye.