AccountId: 011433970860
ContactId: 0162f7fb-15ed-4f41-999b-3d01a0c91f48
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 246490 ms
Total Talk Time (AGENT): 93063 ms
Total Talk Time (CUSTOMER): 123636 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/0162f7fb-15ed-4f41-999b-3d01a0c91f48_20250225T20:03_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from the provider's office to check on the claims.
[AGENT][NEUTRAL] Sure, [PII], I can assist you with claim status. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Yes, so the callback number will be [PII] and no explanation.
[AGENT][NEUTRAL] Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Oh yes, sure.
[CUSTOMER][NEUTRAL] So the policy number will be 02449773.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes, so the patient name will be uh [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you. Now, I need, need his date of birth.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh yes, sure.
[CUSTOMER][NEUTRAL] So, the member's date of birth is on [PII].
[AGENT][NEUTRAL] And what's the date of service and bill charges on the claim, please?
[CUSTOMER][NEUTRAL] Yes, so the date of service is on [PII] for the total charge of $216 even. It's $216 even.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] Let me.
[CUSTOMER][NEUTRAL] This.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You.
[AGENT][NEUTRAL] OK, yes, ma'am. We received that claim on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Just getting information call that.
[AGENT][NEUTRAL] The claim processed and denied on [PII].
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] The claim number is 3553775.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] And it's you know that.
[AGENT][NEUTRAL] And the claim is denying because we need the EOB from the primary insurance company.
[CUSTOMER][NEUTRAL] So you need primary you'll be from primary insurance, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Yes, so do you know, uh, who is the primary payer?
[AGENT][NEUTRAL] No, that's why we need the ELD.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh yes, thank you. So may I know the member's uh eligibility? So when was the member was the factor from?
[AGENT][NEUTRAL] Listen, just let me advise you that verification of coverage does not guarantee payment of claims.
[CUSTOMER][NEUTRAL] Be
[AGENT][NEUTRAL] The effective date on this policy.
[CUSTOMER][NEUTRAL] I'm
[AGENT][NEUTRAL] It was [PII] and the policy is still active.
[CUSTOMER][NEUTRAL] Uh, OK, thank you. So could you please provide me the claim, receipt date, and process it one more time?
[AGENT][NEUTRAL] Yes, ma'am. We received the claim on.
[AGENT][NEUTRAL] [PII], and it also processed on [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, uh, that's perfect. Uh, thank you. So could you please provide me with your name it's for the documentation purpose.
[AGENT][NEUTRAL] Yes, you can, um, well, it'll also be my reference, the reference number is also my name and today's date. My name is [PII]. It's spelled [PII] My last initial is [PII], and today's date is your reference number. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, that's all.
[AGENT][POSITIVE] OK. Well, I thank you again, [PII], for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] Like