AccountId: 011433970860
ContactId: 273eefc8-88df-4a6b-a710-4c99ecf1ba72
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 299880 ms
Total Talk Time (AGENT): 136023 ms
Total Talk Time (CUSTOMER): 63972 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/273eefc8-88df-4a6b-a710-4c99ecf1ba72_20250516T13:09_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling AP Hill. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from provider's office to check on our client status. How are you doing today?
[AGENT][POSITIVE] I'm good, [PII] how are you?
[CUSTOMER][POSITIVE] Yeah, I'm good. Thank you for asking.
[AGENT][NEUTRAL] Good. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII]. Direct line, no extension.
[AGENT][NEUTRAL] Thank you and you're needing claim status for one member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes ma'am, I can help you with that. And [PII], what is the member's policy number?
[CUSTOMER][NEUTRAL] It's 021 348.
[CUSTOMER][NEUTRAL] 82
[AGENT][POSITIVE] Thank you one moment. I believe I spoke to you a few moments ago, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And any information provided as I stated before will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is uh
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII], sorry.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and again, any information provided will be a verification of benefits and not a guarantee of payment. What is your patients, uh, I'm sorry, what is the date of service for her and total bill amount, please?
[CUSTOMER][NEUTRAL] Data service is [PII] with the total charge amount of um
[CUSTOMER][NEUTRAL] It's 273-54.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And you do not already have the claim number, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEGATIVE] OK, so this claim was received on [PII]. It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3574051.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And this claim was denied. The remarks on the denial state that we have received the primary explanation of benefits that was submitted with the claim. However, the explanation of benefits received does not.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] List the amounts applied to the deductible, co-pay or co-insurance. Please submit a more detailed explanation of benefits that shows these amounts for further consideration of your claim.
[AGENT][NEUTRAL] So we need a
[CUSTOMER][NEUTRAL] Mhm. When did you receive that, uh,
[AGENT][NEUTRAL] I, I gave you the dates on when we received and processed this claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, uh, I'm just asking when do you receive the primary OB? It's on the same date?
[AGENT][NEUTRAL] Yes, with the claim, but it did not, it was not detailed. We need a detailed explanation of benefits showing the amounts applied to the deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK, thank you and.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yeah, that's it. Could you please provide me the for reference?
[AGENT][NEUTRAL] Yes, ma'am, it's my name and today's date and again if you need a copy of that explanation of benefits with those remarks that I read, you can print that by going to that same portal [PII].
[CUSTOMER][POSITIVE] OK. Thank you. Have a great day.
[AGENT][POSITIVE] All right, you too, and it was nice speaking to you again, [PII]. So again, if that is all I can help you with, have a great day and thank you for calling APL.