AccountId: 011433970860
ContactId: 3fe23c68-67b7-4f4d-a716-633f1e14abc0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 430429 ms
Total Talk Time (AGENT): 173911 ms
Total Talk Time (CUSTOMER): 110901 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/3fe23c68-67b7-4f4d-a716-633f1e14abc0_20250507T18:40_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is [PII]. I'm calling from a provider office.
[AGENT][NEUTRAL] Could you please spell your first name for me? I didn't understand what you said.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII], and how can I help you today?
[CUSTOMER][NEUTRAL] Uh, I'm calling in regards to a claim.
[AGENT][NEUTRAL] OK, you're needing claim status?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII].
[AGENT][NEUTRAL] Ky, are you there?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What is the member's policy number?
[CUSTOMER][NEUTRAL] The policy number is 02341068 letter M for Mary.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] L for Louis #7.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] It's not about time and you put it on number 10.
[CUSTOMER][NEUTRAL] Normal time.
[AGENT][NEUTRAL] And [PII], any information that I do have for you today 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 [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her, please?
[CUSTOMER][NEUTRAL] Uh, it's um
[CUSTOMER][NEUTRAL] [PII] $2025304.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 304 is the bill amount, is that correct?
[CUSTOMER][NEUTRAL] $304.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK, so this claim was received. It was received.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Excuse me, it was received on [PII].
[AGENT][NEGATIVE] Processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 359.
[AGENT][NEUTRAL] 2024.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And the reason for the denial on this claim is that office visits are not covered by the above numbered policy. The supplemental policycury does not cover office visits.
[AGENT][NEUTRAL] Now if you need a copy of that explanation of benefits with that remark you may print it by going to our portal and using that claim number. Our portal website is located at secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Are you able to fax in the EOB?
[AGENT][NEUTRAL] You're not able to print it?
[AGENT][NEUTRAL] We did mail a copy also.
[CUSTOMER][NEUTRAL] OK. Only mail, no fax.
[AGENT][NEUTRAL] It probably just hasn't had time.
[AGENT][NEUTRAL] Yes, but I'm asking you, can you print? You can't print.
[CUSTOMER][NEUTRAL] OK, can I have the website again secure?
[AGENT][POSITIVE] I'll make sure to put a D on it. It's secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you'll give me just a moment.
[CUSTOMER][NEUTRAL] Uh, so,
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sure that
[CUSTOMER][NEUTRAL] Can I please have the claim number?
[AGENT][NEUTRAL] Yes, ma'am. Uh, you need, do you need for me to give you that again?
[CUSTOMER][NEUTRAL] The claim number, I'm sorry.
[AGENT][NEUTRAL] Mhm. 3592024.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can I have a reference for this call, please?
[AGENT][NEUTRAL] Yes, ma'am, you would use my name that I gave you along with today's date.
[AGENT][NEUTRAL] And [PII], I will go ahead and fax this to you again. One has been mailed and then you can print it yourself from the portal now that you have the claim number.
[AGENT][NEUTRAL] Give me just a moment for it to load and I will fax this one to you.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you. Thank you so much. I greatly appreciate it.
[AGENT][POSITIVE] Mhm. You're welcome.
[AGENT][NEUTRAL] Does it need to have your name on the fax or is that not necessary?
[CUSTOMER][NEUTRAL] Uh yeah, you can put my name on it. [PII]
[AGENT][NEUTRAL] And one moment for me to get your fax number.
[CUSTOMER][NEUTRAL] The fax number is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, again, that is [PII]. Is that correct?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK, so this has been faxed.
[CUSTOMER][POSITIVE] Thank you so much. And, and I'm sorry, I'm gonna ask you if you can spell your name for me again, please.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And my name and today's date?
[CUSTOMER][NEUTRAL] And initial [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. So it's gonna be your name and today's date for reference.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Thank you, [PII], so much for your help today. I greatly appreciate it.
[AGENT][POSITIVE] You're very yes ma'am. You're very welcome, [PII]. So is it that is all I can help you with. Thank you again for calling APL and I hope you have a nice afternoon.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][POSITIVE] You're welcome. Bye bye.