AccountId: 011433970860
ContactId: 2eb8ed24-0257-4f8b-83dc-2f6bd1bc89f7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 323459 ms
Total Talk Time (AGENT): 162583 ms
Total Talk Time (CUSTOMER): 74431 ms
Interruptions: 3
Overall Sentiment: AGENT=0.9, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/2eb8ed24-0257-4f8b-83dc-2f6bd1bc89f7_20250408T17:25_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I was just disconnected I think from [PII] or [PII] I'm not sure, um, but she was looking into a claim for me.
[AGENT][NEUTRAL] OK, so you're needing claim status, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes, ma'am. I can help you with that. And are you the insured or are you calling on behalf of a provider?
[CUSTOMER][NEUTRAL] Provider.
[AGENT][NEUTRAL] OK, yes, ma'am. I can help you with that. And what, who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Can you please spell
[AGENT][NEUTRAL] Your name for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] I have 02150683.
[AGENT][NEUTRAL] OK, thank you one moment while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] A little
[AGENT][NEUTRAL] Any information that I do provide for you today would be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Any information that I provide for you 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] And it's [PII], date of birth of [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount, please.
[CUSTOMER][NEUTRAL] Data service is 627-2024 and the amount of $3,849.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] OK, so I do show this claim was received. Are you going to need the receive date and the process date, Ali?
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] OK, so this claim was received on 9-13-2024.
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is going to be 3,506,840.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] It does show that this claim was denied.
[AGENT][NEUTRAL] And the reason for the denial states.
[AGENT][NEUTRAL] Um, one moment.
[AGENT][NEUTRAL] Insured's primary insurance provided full benefits. There are no benefits payable.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so they pretty much paid all they allow.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It, yes, it shows that the primary page.
[CUSTOMER][POSITIVE] Paid all that was OK.
[CUSTOMER][POSITIVE] Um, that is perfect, and can I get a reference number I'm sorry, go ahead.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] No, no, no, I was gonna say, and if you need a copy of that explanation of benefits, you should be able to print that now that you have the claim number by going to our portal at secured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Yes ma'am. Yes ma'am.
[AGENT][NEUTRAL] It doesn't matter. You can do it all lower case. [PII].
[CUSTOMER][NEUTRAL] OK, OK, [PII] uh huh.
[AGENT][NEUTRAL] Mhm. You have it. [PII]. Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh huh
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] All right, thank you [PII] and can I get a reference number?
[AGENT][NEUTRAL] Well
[AGENT][POSITIVE] Yes ma'am you're gonna use my name along with today's date.
[CUSTOMER][POSITIVE] All right, thank you so much for your help.
[AGENT][POSITIVE] All right. Well, yes, ma'am. You're very welcome. And is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] Um, no, not at this time.
[AGENT][NEUTRAL] And just so you know, it does look like the lady that you were speaking to has called and left you a message on the machine. It's what her note states.
[CUSTOMER][NEUTRAL] Like
[AGENT][NEUTRAL] So I will let her know that I have spoken. OK. I will let her know that I did speak to you, so you will not have to, um, I mean, you can just disregard that unless there was something else that she was helping you with that I haven't. OK. Well, you're welcome. And again,
[CUSTOMER][NEUTRAL] Yep, I just seen that her call came through.
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[CUSTOMER][NEUTRAL] No, nope, that was it.
[AGENT][POSITIVE] OK. Well, thank you again for calling APL. Have a great afternoon.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You too bye bye.