AccountId: 011433970860
ContactId: 43b41294-7506-4e94-98b6-9946893f9264
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 235899 ms
Total Talk Time (AGENT): 92589 ms
Total Talk Time (CUSTOMER): 67167 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/43b41294-7506-4e94-98b6-9946893f9264_20250402T14:09_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], my name is [PII]. I am calling from Knox Community Hospital. I am needing to check the status of a claim, please.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim status, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh yes, ma'am. It's [PII].
[AGENT][NEUTRAL] Thank you and may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02465892
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [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 and the total bills for the claim?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes, ma'am, it's [PII]. Total charge is $3,123.28.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Knox Community Hospital.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 356-9337. OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oops, hold on, hold on.
[CUSTOMER][NEUTRAL] Go ahead start over with that claim number.
[AGENT][NEUTRAL] OK, it's 356.
[AGENT][NEUTRAL] 9337.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because benefits are payable only if the major medical provides benefits.
[AGENT][NEUTRAL] If the claim is later paid by major medical, I'm just provide the explanation of benefits and we can continue processing.
[CUSTOMER][NEUTRAL] OK, so in this one.
[CUSTOMER][NEUTRAL] The major medical did not pay anything, they just put it towards the deductible.
[CUSTOMER][NEUTRAL] So y'all won't cover that, correct? Is that what you're saying?
[AGENT][NEUTRAL] Right, right, if major medical, uh, if major medical doesn't apply to the claim, we can't add second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, that is what I needed to know. So then the balance.
[CUSTOMER][NEUTRAL] Is the patient responsibility. OK.
[CUSTOMER][NEUTRAL] Is there a reference number for our call, Ms. [PII]?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, and the first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much. I appreciate your help.
[AGENT][NEUTRAL] You're very welcome, [PII], and again, all the information provided was a verification of benefits, not a guarantee of payment. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] Um, no, ma'am, I do not believe so.
[AGENT][POSITIVE] Alrighty. Well, thank you for calling APL. I hope you have a great week.
[CUSTOMER][POSITIVE] Thanks you as well.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.