AccountId: 011433970860
ContactId: 40755903-f11e-4b0d-b56a-7269a7880e7e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 321609 ms
Total Talk Time (AGENT): 127684 ms
Total Talk Time (CUSTOMER): 56409 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/40755903-f11e-4b0d-b56a-7269a7880e7e_20250124T17:56_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I am calling to check on a claim status.
[AGENT][POSITIVE] Oh, I'd love to help you with claim status today, [PII]. Do you mind if I snag a quick call back number from you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is the
[AGENT][NEUTRAL] Member ID that we're looking at today.
[CUSTOMER][NEUTRAL] 01792110
[AGENT][POSITIVE] Thank you and give me a moment to get that pulled up for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alrighty, thank you so much. And would you be able to verify for me [PII] the patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] Perfect, I do see him here.
[AGENT][NEUTRAL] And what is the date of service for the claim we wanna look at?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And they build them out?
[CUSTOMER][NEUTRAL] $344.
[AGENT][POSITIVE] Thank you, give me just a second to get that pulled up for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what would be the facility name on file for this claim?
[CUSTOMER][NEUTRAL] SSM Health Medical Group.
[AGENT][NEUTRAL] This is a medical and the provider's name?
[CUSTOMER][NEUTRAL] IJ
[CUSTOMER][NEUTRAL] I have to spell the last name. [PII]
[AGENT][POSITIVE] Thank you I appreciate that.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And looks like I did find that claim for you. I show that we received your claim on [PII]. It appears that we processed the claim [PII].
[AGENT][NEUTRAL] And it looks like your claim number here is.
[AGENT][NEUTRAL] 352-417-3.
[AGENT][NEUTRAL] Yeah
[AGENT][NEGATIVE] And I do show that this claim denied. I have the reason stating that office visits are not covered by the above number policy, and then the other denial code states that the policy provides no benefits for the treatment um of conditions other than a sickness or injury as defined by the policy.
[CUSTOMER][NEUTRAL] OK. Is it possible I can get a copy of the EOB?
[AGENT][POSITIVE] Oh, absolutely. Let me pull one up for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm just waiting for that um fax box to load.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], do you want that made attention to yourself?
[CUSTOMER][NEUTRAL] Uh, you can fax it to me if you can.
[AGENT][NEUTRAL] OK, [PII] [PII]?
[CUSTOMER][NEUTRAL] [PII] [PII] [PII] [PII]
[AGENT][NEUTRAL] OK perfect and what is the fax number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alright, perfect. I'm hitting send on that fax it should come through in the next 5 to 10 minutes and then is there anything else I can do to help you today?
[CUSTOMER][NEUTRAL] Just a reference number for the call.
[AGENT][NEUTRAL] You betcha. It's gonna be my name, [PII], first initial, last name, [PII], and then today's date.
[CUSTOMER][POSITIVE] Alrighty well thank you so much for checking for me [PII] and sending that information to me.
[AGENT][POSITIVE] You bet you. Thank you for calling APL. Hope you have a fabulous day.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][NEUTRAL] Bye bye.