AccountId: 011433970860
ContactId: ff1f97b6-bae3-4e73-9259-1cb1fc1625ed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 713349 ms
Total Talk Time (AGENT): 255625 ms
Total Talk Time (CUSTOMER): 157987 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/ff1f97b6-bae3-4e73-9259-1cb1fc1625ed_20250210T20:30_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] Hi, my name is [PII].
[CUSTOMER][NEUTRAL] Could you please help me with the claim?
[AGENT][POSITIVE] Sure, 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] 4.
[AGENT][NEUTRAL] And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And can you verify the first member's um policy number?
[CUSTOMER][NEUTRAL] Policy ID is
[CUSTOMER][NEUTRAL] 022
[CUSTOMER][NEUTRAL] 96917
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you for that. And do you have um multiple dates of service for one person or there's multiple claims or patients?
[CUSTOMER][NEUTRAL] Multiple patients.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] My's name, [PII], and date of birth, [PII].
[AGENT][NEUTRAL] Thank you, and all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service for the claim and the total bill?
[CUSTOMER][NEUTRAL] D of service of this one, it is [PII]. And the total charge amount is $5,945.88. I just need the claim number.
[AGENT][NEUTRAL] The claim number is 3511964.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Shall we move to the next one?
[AGENT][NEUTRAL] Um, hold on one moment. I have to note each policy.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK, the next member's policy number?
[CUSTOMER][NEUTRAL] It is 014.
[CUSTOMER][NEUTRAL] 23355
[CUSTOMER][NEUTRAL] ML 8.
[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] Member's name, [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Data services
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Total charge amount 700.
[CUSTOMER][NEUTRAL] 97 cents.
[AGENT][NEUTRAL] $700.97.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And did you just need the claim number for that as well, or you need the full claim status?
[CUSTOMER][NEUTRAL] No, no, I need the uh claim numbers.
[AGENT][NEUTRAL] The full claim status?
[CUSTOMER][NEUTRAL] Only only claim number.
[AGENT][NEUTRAL] OK, it's 350-6017.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, the next member's policy number?
[CUSTOMER][NEUTRAL] It is 01475584.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] ML 7.
[AGENT][NEUTRAL] Alright, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Member's name, [PII]. Date of birth [PII].
[AGENT][NEUTRAL] They have an active policy. Let me see if this number is on that policy because they are not on this one. Hold on one second.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify? Hold on one moment.
[AGENT][NEUTRAL] I don't see this.
[AGENT][NEUTRAL] OK, so [PII] is on the new policy. So the new policy number is 1659386.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Um, the policy has been effective since
[AGENT][NEUTRAL] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have the date of service for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] And the total charge is $1,518.89.
[AGENT][NEUTRAL] And it's
[AGENT][NEUTRAL] $1,518.89.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment, and you just need the claim number?
[CUSTOMER][NEUTRAL] Yes. And this was received under the uh the new Plus policy or under the uh expired one?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Let me see, hold on one moment.
[AGENT][NEUTRAL] OK, so the policy number that you gave the 3, 1659386 terminated on [PII]?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] This was processed under
[AGENT][NEUTRAL] Hold on.
[AGENT][NEUTRAL] Wait a minute, I'm sorry. I did that backwards. The policy number that you gave 1475584, um,
[AGENT][NEUTRAL] Terms on
[AGENT][NEUTRAL] [PII]. So it's active from [PII]. The active policy is the 1659386 that's been active since [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's the policy, the claim was processed under, the active policy.
[CUSTOMER][NEUTRAL] OK. And, OK, thank you. And what's the claim number?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] What's the claim number?
[AGENT][NEUTRAL] The claim number is 354.
[AGENT][NEUTRAL] 8284.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And uh one last thing, uh, that it was denied due to Prime DUB. Can you please check?
[AGENT][NEUTRAL] Right, was it not requesting the explanation of benefits from primary.
[CUSTOMER][POSITIVE] Sure. OK, thank you. I have the last one.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, and the last member's policy number?
[CUSTOMER][NEUTRAL] It is 022.
[CUSTOMER][NEUTRAL] 03 089.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Ms name [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Date of service is [PII] and the total charge is $756.81.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] Alright, so we actually received this claim twice on the first claim, uh, we received it on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3516957.
[AGENT][NEGATIVE] Oh, actually, this is the 2nd 1, and I'm showing that it was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that actually was the 2nd um time we received it. Did you need the original entry?
[CUSTOMER][NEUTRAL] OK. And could you please also confirm the claim number that was received again?
[AGENT][NEUTRAL] Yes, it is 347-977-1.
[AGENT][NEUTRAL] We received the claim on [PII].
[AGENT][NEGATIVE] And on [PII], it was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, because it's showing that the major medical insurance has paid, um, all the provided all benefits. If you have an explanation of benefits that shows, um, where the claim was paid.
[AGENT][NEUTRAL] Um, you can just send the explanation of benefits and we'll continue processing.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No. Thank you, thank you for your help.
[AGENT][POSITIVE] You're welcome, [PII]. Well, thank you for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] Yeah.