AccountId: 011433970860
ContactId: 45948137-b166-45ee-b5b3-3c0246af3eb4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 269000 ms
Total Talk Time (AGENT): 99869 ms
Total Talk Time (CUSTOMER): 99175 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/45948137-b166-45ee-b5b3-3c0246af3eb4_20250423T17:50_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from uh SSM Health Medical Group, and I just need to get claim status on one patient.
[AGENT][NEUTRAL] OK, well I can help you with the claim status and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Absolutely. My direct line is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02497336.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it is [PII] [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 bill for the claim?
[CUSTOMER][NEUTRAL] Absolutely. Uh, the data service is 101 of 24, and it was $350 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You guys answered very quickly. I was surprised.
[AGENT][POSITIVE] That's funny.
[CUSTOMER][NEUTRAL] Most of our payers um waiting on hold at least 30 minutes before they answer.
[AGENT][NEGATIVE] Oh my gosh. I hope we never get like that.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEGATIVE] It's so bad, it's so common that in our meeting yesterday, um, our manager was like, we know that the majority of the payers are 30 minutes at the moment, and I'm like, we're like 45 to an hour.
[AGENT][NEGATIVE] Good Lord, that's, I didn't, that's insane.
[CUSTOMER][POSITIVE] Oh yeah, just, just even get a wrap.
[AGENT][NEUTRAL] Mm mm.
[CUSTOMER][NEUTRAL] That's crazy.
[AGENT][NEUTRAL] Is this, hold on one moment. Hu entity, yes. Do you mind?
[CUSTOMER][NEGATIVE] I'm like, I hope it never gets like that here.
[AGENT][NEUTRAL] Do you, do you mind if I place you on just a brief hold?
[CUSTOMER][POSITIVE] No, no, take your time.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] That's because it was.
[AGENT][NEUTRAL] OK, so 734 is what?
[AGENT][NEUTRAL] 71.
[AGENT][NEUTRAL] OK, hello [PII].
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Alright, thank you so much for holding. I apologize for that wait. I just had to um get to the total bill here, but I am showing that we received the claim on [PII].
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim number is 352.
[AGENT][NEUTRAL] 0734.
[CUSTOMER][NEUTRAL] You said 352-073-4, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then on [PII], the claim was denied.
[AGENT][NEGATIVE] And it was denied because the policy provides no benefits for treatment other than sickness or injury listed on the policy. So it's not a cover charge.
[CUSTOMER][NEUTRAL] OK, um, under the, the patient's plan or under period? It's not a cover charge?
[AGENT][NEUTRAL] Well, uh, so I guess both is not a covered charge under the patient's policy.
[CUSTOMER][NEUTRAL] OK, so not covered under the policy, OK.
[CUSTOMER][NEUTRAL] And that was on [PII]. OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK perfect um and then [PII] do you guys do call reference numbers?
[AGENT][NEUTRAL] No, ma'am, it'll just be my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Perfect. Thank you so much. I was gonna ask you that. All right, that's all I needed. Thank you very much. I really appreciate your help.
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][POSITIVE] Thank you, bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.