AccountId: 011433970860
ContactId: 17c72ebd-113b-4199-8191-90d9a9479e92
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 247149 ms
Total Talk Time (AGENT): 122710 ms
Total Talk Time (CUSTOMER): 54524 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=2.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/17c72ebd-113b-4199-8191-90d9a9479e92_20250401T12:05_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] Hey, good morning, [PII]. My name is [PII]. I'm calling for the provider Emery Clinic. I was calling to get status on the medical claim, please.
[AGENT][NEUTRAL] OK, [PII], so you're needing to get claim status for one member, is that correct?
[CUSTOMER][NEUTRAL] Yes, one member, yes.
[AGENT][POSITIVE] Yes, sir, I can help you with that. And [PII], what is a good callback number for you, please? Oh, you're welcome.
[CUSTOMER][POSITIVE] I appreciate that.
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please [PII].
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] They have down here 194-0769 [PII].
[AGENT][POSITIVE] OK, thank
[AGENT][POSITIVE] Alright, thank you. Give me just a moment to get the member's information all pulled up please.
[CUSTOMER][POSITIVE] OK thanks.
[AGENT][NEUTRAL] Mhm, sure.
[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. OK, I heard you said that her name was [PII]. What is her date of birth, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And the date of service, please, and total bill amount.
[CUSTOMER][NEUTRAL] The date of services [PII] $362 even.
[AGENT][NEUTRAL] 362, is that correct?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] Mhm you're welcome.
[AGENT][NEUTRAL] OK, so I do see that this claim was received, DJ, the received date on it was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This claim number is 357.
[AGENT][NEUTRAL] 9788.
[AGENT][NEUTRAL] And at this time, this claim has been denied, DJ. The reason for the denial states please provide copies of your explanation of benefits from your primary insurance carrier.
[AGENT][NEUTRAL] Because this is a supplemental policy, DJ, we always have to have the primary insurance company's explanation of benefits for this type of claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is there a reference number for this call, uh, [PII]?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] I, it's [PII] That's OK. Uh you're gonna use my name along with today's date and then DJ, if you do need a copy of this explanation of benefits, we do have a portal in which you can go to to print that.
[CUSTOMER][NEUTRAL] I mean [PII].
[CUSTOMER][POSITIVE] Yeah, I'm sorry.
[AGENT][POSITIVE] And our portal is secured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else that I can help you with this morning?
[CUSTOMER][POSITIVE] Uh, no, that's it. I appreciate it. You have a great day.
[AGENT][POSITIVE] Well, you are certainly very welcome. Yes, sir. I hope you have a great day too, and thank you again for calling APL this morning.
[CUSTOMER][POSITIVE] Thank you bye.
[AGENT][NEUTRAL] Ah, bye bye.
[CUSTOMER][NEUTRAL] Bye bye.