AccountId: 011433970860
ContactId: 234d6482-212d-4c1c-9ac4-ad30aa27c47f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 323309 ms
Total Talk Time (AGENT): 139192 ms
Total Talk Time (CUSTOMER): 38827 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/234d6482-212d-4c1c-9ac4-ad30aa27c47f_20250502T19:08_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] Hey, [PII], my name is [PII]. I'm calling from a provider's office about a claim.
[AGENT][NEUTRAL] OK. Did you say your name is [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK, and you're needing to check claim status on a member, [PII], is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. And what is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number please [PII]?
[CUSTOMER][NEUTRAL] 02595081
[AGENT][NEUTRAL] OK, thank you, one moment please.
[AGENT][NEUTRAL] And any information that I do provide today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the date of service and total bill amount please?
[CUSTOMER][NEUTRAL] 319 of 25 388
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I showed this claim was received on [PII]. I'm sorry, let me look again.
[AGENT][NEUTRAL] It's received on [PII] and processed on [PII].
[AGENT][NEUTRAL] The claim number on this claim is going to be 35.
[AGENT][NEUTRAL] 93.
[AGENT][NEUTRAL] Actually, no, it's not. Bear with me just one second, [PII], let me refresh one of these screens.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let's try this again. OK, so the claim number is 3584494.
[AGENT][NEUTRAL] And this claim was denied. The reason for the denial on this claim states.
[AGENT][NEUTRAL] We are awaiting information to confirm eligibility from benefits and a card.
[AGENT][NEUTRAL] Upon receipt of this information, we will continue processing your claim.
[AGENT][NEUTRAL] So we're waiting to confirm eligibility for this data service.
[CUSTOMER][NEUTRAL] OK, so they're, I'm not understanding.
[AGENT][NEUTRAL] From their enrollment company.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And once we receive that then as stated, we will continue reviewing the claim.
[CUSTOMER][NEUTRAL] All right. Is that something that the member needs to submit?
[AGENT][NEUTRAL] No ma'am, it isn't it's just something that the employer will provide to us.
[CUSTOMER][NEUTRAL] Employer, OK, OK.
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[AGENT][NEUTRAL] And is there anything else, [PII], that I could help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, that is all. If I can just get a reference.
[AGENT][NEUTRAL] Sure, you would use my name along with today's date and then [PII], if you need a copy of this primary or not of our explanation of benefits, we have a portal that you should be able to print that from and the website for the portal is [PII].
[CUSTOMER][POSITIVE] OK, sounds good. Thank you so much.
[AGENT][POSITIVE] Alright, well you are certainly very welcome so again if that is all I can help you with, thank you so much for calling APL and I hope that you have a great weekend.
[CUSTOMER][POSITIVE] Thanks, you too.
[AGENT][POSITIVE] Thank you, [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] Uh-huh. Bye bye.