AccountId: 011433970860
ContactId: 2b563ccf-eb0b-4cab-9d81-a0d95289dade
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 259519 ms
Total Talk Time (AGENT): 109835 ms
Total Talk Time (CUSTOMER): 70518 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/2b563ccf-eb0b-4cab-9d81-a0d95289dade_20250423T18:45_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from Geisinger Clinic, and I'm calling to check the status of a claim.
[AGENT][POSITIVE] All right, [PII], I'm happy to check on a claim for you. What's the patient's policy number?
[CUSTOMER][NEUTRAL] 02572295
[AGENT][POSITIVE] OK, thank you for that.
[AGENT][NEUTRAL] And then if I could get patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name, [PII] [PII].
[AGENT][NEUTRAL] Thank you. So [PII] is active. Effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you need any other benefits from the member's plan?
[CUSTOMER][NEUTRAL] Um, I, I actually need need claim status.
[AGENT][POSITIVE] Oh, yeah, absolutely. What's the data service? I'm sorry.
[CUSTOMER][NEUTRAL] Sure, 221, 2025.
[AGENT][NEUTRAL] 1021 of 25.
[AGENT][NEUTRAL] And then what was the bill amount?
[CUSTOMER][NEUTRAL] $63.00.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] And it was [PII], correct?
[CUSTOMER][NEUTRAL] No, it was 221-2025.
[AGENT][NEUTRAL] $63 let's see.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Don't know, it looks like we did get a claim for this.
[AGENT][NEUTRAL] Uh, let me see what the received date was. Claim was received on [PII].
[AGENT][NEUTRAL] Uh, it looks like it was denied same date. Diagnostic benefits payable for MRI, colonoscopy, or CT only. So it looks like whatever testing the patient had done was not a covered test.
[CUSTOMER][NEUTRAL] OK. Um, and an explanation of benefits went out?
[AGENT][NEUTRAL] Yeah, it would have went out on [PII]. Um, we can send you a provider one if you need it.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] If you wouldn't mind and then I can take care of this, I'll apply the denial.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Absolutely. Do you have a fax number I can send it to?
[CUSTOMER][NEUTRAL] Uh yes. [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And um if you would send it attention, [PII]
[AGENT][NEUTRAL] OK. Just to confirm that number, it was [PII]. Is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] All right, [PII]. I'm sending that your way. Give it about 5 minutes. Is there anything else I can check on for you?
[CUSTOMER][POSITIVE] No, that's it. Thank you very much. Oh, and your name was?
[AGENT][NEUTRAL] My name is [PII], which is spelled [PII] The [PII] my [PII] is [PII], and that is the call reference with today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Great. OK. Thank you so much for your help, [PII]. That's everything I needed, so you have a good day.
[AGENT][POSITIVE] You're you too. Bye-bye.