AccountId: 011433970860
ContactId: 1e841626-1fab-4ed5-877e-588e0809ff36
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 235500 ms
Total Talk Time (AGENT): 115517 ms
Total Talk Time (CUSTOMER): 60859 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/1e841626-1fab-4ed5-877e-588e0809ff36_20250113T18:06_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 looking for a claim status on a patient, please.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, I can help you with that, [PII]. And what is your callback number?
[CUSTOMER][NEUTRAL] It is [PII] no [PII].
[AGENT][NEUTRAL] [PII]. Is that correct? The last four numbers? OK, thank you.
[CUSTOMER][NEUTRAL] Yes ma'am. [PII], I'm sorry, [PII]. I'm sorry.
[AGENT][NEUTRAL] [PII]. OK. Thank you. And what is the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Yes, yeah. Mhm.
[CUSTOMER][NEUTRAL] Looks like it's through her husband but it's 01723179.
[AGENT][POSITIVE] OK, thank you. Give me just a couple of moments to get the information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information [PII] 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 their date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. Date of birth is uh [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Sure, it is [PII] and the bill amount is $455.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I do see that this claim was received. [PII], the receipt, do you need to know the received date and process date or just the claim number and the status?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Um, no, the receipt date would be great. Thank you.
[AGENT][NEUTRAL] OK. It was received on [PII].
[AGENT][NEUTRAL] Processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3,471,080.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the reason for the denial states benefits.
[AGENT][NEUTRAL] Payable under this certificate are limited to those outlined on the schedule of benefits. This is not a covered loss under the plan. Therefore, no amount payable for this expense.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], if, if you've never been given our portal website, we do have a portal that you can set up the profiles and be able to print the EOB if you do not have that, and our portal website is secured.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you would just register and you be able to use that claim number to have access to that EOB.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Perfect, perfect. Do you have a um call reference number for this call?
[AGENT][NEUTRAL] Yes, ma'am. You would actually just use my name along with today's date.
[CUSTOMER][POSITIVE] Perfect. Thank you so much, [PII]. You have a wonderful day, OK?
[AGENT][POSITIVE] Well, I hope you do too, [PII], if that's all I can help you with, thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.