AccountId: 011433970860
ContactId: 11b133bf-2108-4827-a425-1626ec1bd592
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 308399 ms
Total Talk Time (AGENT): 135452 ms
Total Talk Time (CUSTOMER): 70737 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/11b133bf-2108-4827-a425-1626ec1bd592_20250217T17:57_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from the office to check the claim status.
[AGENT][NEUTRAL] What is your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, OK, [PII], and you're needing, and you're needing to check claim status, is that correct?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] Yeah, the callback number is uh
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then how many claims first off, [PII], do you have to check claim status on?
[CUSTOMER][NEUTRAL] So only one claim?
[AGENT][NEUTRAL] OK. And what is that member's policy number, please?
[CUSTOMER][NEUTRAL] 02 5
[CUSTOMER][NEUTRAL] 14,350.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Give me just a moment [PII] while the member's information is loading.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you 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] The patient's last name is [PII] and the first name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] What you know.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] The data service is uh [PII] and the bill amount is
[CUSTOMER][NEUTRAL] $6,944.65.
[AGENT][NEUTRAL] I'm sorry, give me the bill, ma'am again. I did not understand you.
[CUSTOMER][NEUTRAL] Yes, uh, $6,944.65. 6944.65.
[AGENT][NEUTRAL] And the date of service was [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes, right.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So this claim was received in just one moment and I'll provide you that information.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] 986
[CUSTOMER][NEUTRAL] And I'm like
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so this claim was received on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3542358.
[AGENT][NEUTRAL] And this claim was denied?
[AGENT][NEUTRAL] The reason for the denial is that we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK. How can we send the UB?
[AGENT][NEUTRAL] You may fax that to our secured fax line at [PII].
[CUSTOMER][NEUTRAL] Can you provide me the fax number?
[AGENT][NEUTRAL] Mhm. Again, the fax number is [PII]. Attention claims.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Yeah, there's any time refilling limit for this?
[AGENT][NEUTRAL] The timeline filing limit.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] There is no timely filing limit?
[AGENT][NEUTRAL] But once we have received the necessary information and processed the claim, we do have a portal in which you can also check claim status and print the explanation of benefits for our company by going to [PII].
[CUSTOMER][NEUTRAL] Can you give me
[CUSTOMER][NEUTRAL] Can
[CUSTOMER][NEUTRAL] OK, can you provide me the call reference number for this?
[AGENT][NEUTRAL] You would use my name that I gave you, [PII], along with today's date.
[CUSTOMER][POSITIVE] Yeah, OK. Thank you so much for the kind information. I appreciate your patience. Have a great day.
[AGENT][POSITIVE] Well, absolutely, you're very welcome. And if that's all I can help you with, and thank you again for calling APL and I hope you have a nice day also.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Bye bye.