AccountId: 011433970860
ContactId: 3f850c3e-b396-4f1b-acb4-5791874fed18
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 272079 ms
Total Talk Time (AGENT): 112976 ms
Total Talk Time (CUSTOMER): 63519 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/3f850c3e-b396-4f1b-acb4-5791874fed18_20250314T12:54_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from Pro office checking on a claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] is the direct line.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02519291
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the date of the [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?
[CUSTOMER][NEUTRAL] Um, the data services and.
[CUSTOMER][NEUTRAL] Just a moment time.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] It's 10 $3,407.39.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So we originally received the claim on [PII]. It was denied because the um requesting an explanation of benefits from primary insurance. Then it looks like we received it again. Hold on, let me get the second one. Hold on one moment.
[AGENT][NEUTRAL] We received it again on [PII]. Um, that claim number is 3567055.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the primary insurance provided full benefits.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEGATIVE] The second claim that was received was denied because once we receive the explanation of benefits, it shows primary provided full benefits, so there was nothing to pay towards.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Primary process for full benefit, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, what is the allowed amount, uh,
[AGENT][NEUTRAL] Let's see what was used. Hold on one second.
[AGENT][NEUTRAL] So it's up to $500 per occurrence.
[AGENT][NEUTRAL] Would be the allowed amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and could you send me the copy of your withdrawal fax number?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] It's uh
[CUSTOMER][NEUTRAL] 844
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And would that be attention Max?
[CUSTOMER][NEUTRAL] Just put attention member name [PII].
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, remember name.
[AGENT][NEUTRAL] The, the patient's name? OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and did you want both explanation benefits or just the, the last one that was sent in?
[CUSTOMER][NEUTRAL] Yes, it's the last one. It's a primary paid uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'll go ahead and send this over to you now, [PII], was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No, can I get the uh reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII]. My first name is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, uh thank you, thank you, thank you for your assistance.
[AGENT][POSITIVE] You're welcome, [PII] Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, thank you. Thank you for your assistance.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. I hope you have a great weekend.
[CUSTOMER][POSITIVE] Great weekend. Bye-bye.
[AGENT][NEUTRAL] Bye bye.