AccountId: 011433970860
ContactId: 1eec57cd-f0a4-417a-a9d6-4787c052eada
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 286149 ms
Total Talk Time (AGENT): 116957 ms
Total Talk Time (CUSTOMER): 63116 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/1eec57cd-f0a4-417a-a9d6-4787c052eada_20250611T14:25_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] Uh, my name is [PII]. I'm calling from, uh, Prisma Health provider office trying to check uh claims.
[AGENT][POSITIVE] OK, well I'll be more than happy to help you with the claim, [PII], and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you, and it's really hard to hear you. Um, is there any way you sound really far away?
[CUSTOMER][NEUTRAL] Uh, is it clear now?
[AGENT][NEUTRAL] Yes, it is, and how many claims do you have in total today, [PII]?
[CUSTOMER][NEUTRAL] One
[AGENT][NEUTRAL] OK, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] It's 02456437.
[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] Our member's name is uh [PII]
[CUSTOMER][NEUTRAL] And date of birth [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 and the total bill for the claim?
[CUSTOMER][NEUTRAL] Uh, data services 213-2025.
[CUSTOMER][NEUTRAL] 22 28 2025 and uh build on $3,348 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It's uh Prisma Health Ocano Memorial Hospital.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So I'm showing that we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 359.
[AGENT][NEUTRAL] 8039.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Requesting a detailed explanation of benefits that shows the amounts that were applied to the deductible, co-pay and co-insurance.
[CUSTOMER][NEUTRAL] I need a primary UB to process the client.
[AGENT][NEUTRAL] We received the EOB, but we need the, it doesn't, it has zeros on what we're asking for. So we're asking for a primary explanation of benefits that has amounts listed for the deductible, co-pay and co-insurance.
[CUSTOMER][NEUTRAL] OK, uh, how do you, uh, accept, uh, UOB, uh, do you accept uh through email address, uh, mailing address?
[AGENT][NEUTRAL] Um, no.
[AGENT][NEUTRAL] You can mail it, you can fax it, or you can send it to us electronically. Our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, I have a fax number?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK, and for whom attention we need to send uh UOB.
[AGENT][NEUTRAL] Um, attention APL claims department.
[CUSTOMER][NEUTRAL] Uh, may I know the electronic ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK, uh, may I know the reference number for this one?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Uh, could you please spell your first name?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] OK, thank you so much for answering all my queries. Have a great day.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] I don't have anything to ask but thank you.
[AGENT][POSITIVE] Alright, well thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] Alright