AccountId: 011433970860
ContactId: 3cfd564b-c796-4dcd-af05-5d15c42c1fa2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 279959 ms
Total Talk Time (AGENT): 118503 ms
Total Talk Time (CUSTOMER): 107499 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/3cfd564b-c796-4dcd-af05-5d15c42c1fa2_20250514T16:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good afternoon, [PII]. My name is [PII], and I'm calling from neuroskeletal imaging, and I need to get assistance with the claim, please.
[AGENT][NEUTRAL] Sure, I can take a look at that claim for you. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Got it, thank you.
[CUSTOMER][NEUTRAL] Last initial [PII] OK.
[AGENT][NEUTRAL] Thank you, um, [PII], can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] 024248882.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member please?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, [PII] [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that. OK, and we were just needing to check on the general claim status or were you needing clarification on that claim?
[CUSTOMER][NEUTRAL] Well, no clarification, we received the explanation of benefits, um, and it states please provide copies of your explanation of update.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'll take a look at that. um, do you have that claim number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know, I don't know if it has, oh, it's only one claim number on here, so it's 3591677.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so I am showing 2 items, let me see for this claim.
[CUSTOMER][NEUTRAL] So yeah it's 2 different data of service.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Is that right? OK, just wanted to make sure we're looking at the same thing. OK, so yeah, it's the um primary EOB that we're needing. I'm sorry that's not very clear on that um now for the.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So if you receive the claim, the ELBs are attached.
[AGENT][NEUTRAL] The primary EOB?
[CUSTOMER][NEUTRAL] So is there a way for you to put yes.
[CUSTOMER][NEUTRAL] For both dates of service it came along with.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] I messed up.
[CUSTOMER][NEUTRAL] No, only 47 is there 48 is 4725 ELB is attached, not 8224, so that's why.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] OK, so I'm, I'm looking at the years there to make sure because I do see before 7 that one denied as their outpatient benefit had reached its maximum. So before you go to the trouble of um sending that other, let me go ahead and double check for [PII] uh to see if he had used all of that benefit as well. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so last year for [PII], um, [PII] has used uh $1,885.88 of the outpatient benefit so you should be good for that one.
[CUSTOMER][NEUTRAL] OK, OK, so I can just fax them along. Do I need to send a new claim or can I just send the explanation of benefits?
[AGENT][NEUTRAL] No ma'am, yes, just the explanation of benefits is perfectly fine, um, and then of course if you would reference uh the policy number and then um the claim number would be helpful as well and we'll be able to link that information.
[CUSTOMER][NEUTRAL] OK, well
[CUSTOMER][NEUTRAL] OK, what I'll do I'll send a copy of the explanation of benefits because it has.
[CUSTOMER][NEUTRAL] Everything on it.
[AGENT][POSITIVE] Yeah, perfect. Alright, did you have any other questions for me, [PII]?
[CUSTOMER][NEUTRAL] Do it
[CUSTOMER][NEUTRAL] No, that is it. May I have the reference number for the call, Ms. [PII]?
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] That would just be my first name, last initial, and today's date. Uh so my name is spelled [PII], last [PII]
[CUSTOMER][POSITIVE] OK perfect, have an amazing day Miss [PII].
[AGENT][POSITIVE] Of course, you too. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.