AccountId: 011433970860
ContactId: 4849cafa-6f63-49ac-96f9-18527e09980a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 228000 ms
Total Talk Time (AGENT): 80310 ms
Total Talk Time (CUSTOMER): 84282 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/4849cafa-6f63-49ac-96f9-18527e09980a_20250401T14:04_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] and I'm calling from the office.
[CUSTOMER][NEUTRAL] Uh, actually I want to know the claim status, so could you help me with that please?
[AGENT][POSITIVE] Sure, 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] Sure. It's [PII].
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today, [PII]?
[CUSTOMER][NEUTRAL] Uh, a single claim.
[AGENT][NEUTRAL] OK, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure. Start with the letter Y as in Yankee, U as in umbrella, P as in Papa, 827319322.
[AGENT][NEUTRAL] OK, so that's not an APL policy number. Do you have the member's ID card available?
[CUSTOMER][POSITIVE] Oh yes, please wait, let me check for another one.
[AGENT][NEUTRAL] Sure, OK.
[CUSTOMER][NEUTRAL] OK. It's, OK, start with 0246.
[CUSTOMER][NEUTRAL] 2880.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] It be.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, member's name is, uh, [PII].
[CUSTOMER][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] [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 and the total bill?
[CUSTOMER][NEUTRAL] Sure. Uh, [PII].
[CUSTOMER][NEUTRAL] And the charges is $6,283.
[AGENT][NEUTRAL] So that's um [PII] $6,283.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, Hillcrest Medical Center.
[AGENT][NEUTRAL] OK, here we go. So I'm showing the claim was received on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 355.
[AGENT][NEUTRAL] 92
[AGENT][NEUTRAL] 22
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting an explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Could you please repeat your name and the call reference please?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name, which is [PII] [PII].
[CUSTOMER][NEUTRAL] In
[CUSTOMER][POSITIVE] OK, thanks [PII] for giving information and have a good day. Goodbye.
[AGENT][NEUTRAL] You're welcome, [PII].
[AGENT][POSITIVE] You also, was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] No, thanks for giving all the information.
[AGENT][POSITIVE] Alright, thanks for calling APL bye bye.
[CUSTOMER][NEUTRAL] Bye for now.