AccountId: 011433970860
ContactId: 25fcb261-a1b8-4f9e-9dba-4140dcef8100
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 323619 ms
Total Talk Time (AGENT): 95908 ms
Total Talk Time (CUSTOMER): 55269 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/25fcb261-a1b8-4f9e-9dba-4140dcef8100_20250310T20:18_UTC.wav
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[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is An[PII]How may I help you?
[CUSTOMER][NEUTRAL] Hi An[PII]my name is Pe[PII]I'm calling regarding a claim.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with your claim, and Pe[PII]may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, 56[PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02451262
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] OK thank you
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, this is for Ad[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 you'd like me to check on?
[CUSTOMER][NEUTRAL] Um, 62[PII].
[CUSTOMER][NEGATIVE] So I called originally you guys didn't have the claim, so I rebuild it and now they're denying it a duplicate.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold while I take a look at the claims? All right, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Pe[PII].
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait. I just want to make sure I had everything. So, I'm sorry that you were told the wrong information. We actually have received this claim now a total of 3 times. Um, the first claim we received or the first time we received the claim was Au[PII].
[AGENT][NEUTRAL] Um, Au[PII]that claim number is 3490198. That claim was denied, the original claim was denied because the calendar year max for outpatient had been met.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so is he responsible?
[AGENT][NEUTRAL] So we don't determine patient responsibility because we're not a major medical, um, it would be whatever your policies are for outstanding or remaining balances.
[CUSTOMER][NEUTRAL] OK, can I get a copy of that original denial?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] 56[PII].
[AGENT][NEUTRAL] And should I put attention, Pe[PII]?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Alright, and that's 56[PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Alright, so I'll go ahead and send this over to you now. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] No, can I just get a reference number for the call?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name on today's date, and again, that's An[PII]first initial of my last name is L [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK An[PII]all right, thank you so much bye bye.
[AGENT][NEUTRAL] You