AccountId: 011433970860
ContactId: 4ea45c13-53b6-4757-bc68-839c0d26e461
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 203809 ms
Total Talk Time (AGENT): 77806 ms
Total Talk Time (CUSTOMER): 70357 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/4ea45c13-53b6-4757-bc68-839c0d26e461_20250408T14:30_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, good morning, [PII]. My name is [PII] and I'm calling the provider of office. Is there a way that I could check the status of medical claim?
[AGENT][POSITIVE] Yes, I'll be more than happy to help you with the medical claim status and why may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, my contact number is [PII] extension will be [PII].
[AGENT][NEUTRAL] OK, and the phone kind of broke up after you said the [PII] and then I heard [PII]. What were the other two numbers?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] The policy number is 02458749.
[AGENT][NEUTRAL] 749.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, the patient name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Hold on one moment.
[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 you like me to check on?
[CUSTOMER][NEUTRAL] Uh, the data servicing question is [PII], and the total charge will be $17,340.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] 17 hold on one moment.
[CUSTOMER][NEUTRAL] especially
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Um, the group name is Physician Practices of MSMC, and the rendering provider is Doctor [PII].
[AGENT][NEUTRAL] Thank you for that, and I'm sure you received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim number is 358.
[AGENT][NEUTRAL] 1809.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied, requesting an explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, alright, thank you, [PII], and do you have any call reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] All right thank you so much.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that's it thank you so much for your help.
[AGENT][POSITIVE] Alright well thanks for calling APL Way and I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you bye bye.