AccountId: 011433970860
ContactId: 192f15c1-fd21-4854-ae2a-2f9a569aed1b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 216130 ms
Total Talk Time (AGENT): 85292 ms
Total Talk Time (CUSTOMER): 87540 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/192f15c1-fd21-4854-ae2a-2f9a569aed1b_20250304T14:10_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII] and I'm with OU Health Partners, and I'm just checking on the status of two claims.
[AGENT][POSITIVE] OK, well I'll be more than happy to help you with the claim status, [PII]. How are you doing today?
[CUSTOMER][POSITIVE] I'm doing OK. How about yourself?
[AGENT][POSITIVE] I'm doing well, thanks for asking. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's a direct line at [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02268420
[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] Yes, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Uh, there are two claims, both of them for the data service 123 of 2024. 1 of them is for $39 the other is $798.
[AGENT][NEUTRAL] OK, thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and I have them both here and can you um verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Uh, yeah, let me see if it's the same on both of them.
[CUSTOMER][NEUTRAL] Uh, the billing provider was [PII] on the 39.
[CUSTOMER][NEUTRAL] Dollar and [PII] on the $798.
[AGENT][NEUTRAL] OK, and it looks like, OK, we received the mail. OK, so the one for $39 we received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim number is 353.
[AGENT][NEUTRAL] 9167.
[AGENT][NEUTRAL] And on [PII], the claim was denied, requesting an explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK. That's what I was kind of wondering because we show she has other insurance.
[CUSTOMER][NEUTRAL] Uh, as well, so, OK.
[CUSTOMER][NEUTRAL] All right, and then the same one I'm sure for the $798.
[AGENT][NEGATIVE] Yes, for that one, it's denied for the same reason. We received it and processed it on [PII].
[AGENT][NEUTRAL] And that claim number is 353-9173.
[CUSTOMER][POSITIVE] OK great I will get that fixed and taken care of and [PII] is there a uh call reference number for this?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, and the first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK. All right, thank you very much for your help. I do appreciate it.
[AGENT][POSITIVE] You're very welcome, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that'll take care of it. You have a good day.
[AGENT][POSITIVE] You also, and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm bye bye.