AccountId: 011433970860
ContactId: 20ee6e4f-5dba-4e51-9ab9-7ede81fceded
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 318459 ms
Total Talk Time (AGENT): 132593 ms
Total Talk Time (CUSTOMER): 59375 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/20ee6e4f-5dba-4e51-9ab9-7ede81fceded_20250409T14:49_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] Hi, [PII]. This is [PII] calling from Proder office checking on a claim status.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check claim status on, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII] is a direct line.
[AGENT][NEUTRAL] OK, thank you. And [PII], my name is [PII]
[AGENT][NEUTRAL] And what is
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] Your patient's policy number, [PII]?
[AGENT][NEUTRAL] T A C I, [PII].
[CUSTOMER][NEUTRAL] Oh, OK, [PII]. I got it.
[AGENT][NEUTRAL] OK, thank you. And what is the patient's policy number, [PII]?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] 024
[CUSTOMER][NEUTRAL] 82,900.
[AGENT][POSITIVE] OK, thank you. Give me a couple of moments for you guys to get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] As and the date of this [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Deals
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the bill amount is $6,466 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, [PII], so this claim was received, the received date was 1-13-2025.
[AGENT][NEGATIVE] It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3551953.
[AGENT][NEUTRAL] And the reason for the denial states, please provide copies of your explanation.
[AGENT][NEUTRAL] Of
[AGENT][NEUTRAL] Benefits. We're needing the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK. Could you verify the process date one more time, uh, [PII]?
[AGENT][NEUTRAL] Yes, one moment.
[AGENT][NEUTRAL] It was pro this claim was processed, [PII] Oh, hang on a moment.
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] In [PII].
[CUSTOMER][NEUTRAL] OK, [PII]. Can I get the fax number, [PII]?
[AGENT][NEUTRAL] And again,
[AGENT][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] 23 attention claims.
[AGENT][NEUTRAL] And [PII], if you need a copy of this explanation of benefits, you may print that from our portal by going to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, crazy.
[CUSTOMER][NEUTRAL] Uh, can I get the reference number crazy?
[AGENT][POSITIVE] Yes, so you will actually use my name along with today's date.
[CUSTOMER][POSITIVE] OK, crazy. Thank you. Thank you for your assistance.
[AGENT][POSITIVE] Well, you're welcome. And is there anything else, [PII], that I can help you with today?
[CUSTOMER][POSITIVE] No, thank you. Thank you for your assistance.
[AGENT][POSITIVE] OK. Well, you're very welcome and thank you again for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Have a great day. Bye-bye.
[AGENT][NEUTRAL] Uh, bye-bye.