AccountId: 011433970860
ContactId: 54b345a6-611c-4bb4-84ee-d09b7e5367af
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 244179 ms
Total Talk Time (AGENT): 88583 ms
Total Talk Time (CUSTOMER): 65318 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/54b345a6-611c-4bb4-84ee-d09b7e5367af_20250327T18:20_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, this is [PII] calling from provider's office to check on a claim status.
[AGENT][POSITIVE] OK, well I'll be more than happy to help you with the claim status, [PII], and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII]. It's a direct line. May I get your name, please?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it's 02506184.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the patient's name is [PII] and the 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. May I have the date of service for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] Sure. It's [PII], 2024 and the total bill amount is
[CUSTOMER][NEUTRAL] The total bill amount is $10,590 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the
[AGENT][NEUTRAL] The um provider on the claim, my apologies.
[CUSTOMER][NEUTRAL] Yes, uh, it's uh
[CUSTOMER][NEUTRAL] Grandstand Regional Medical Center.
[AGENT][NEUTRAL] Alright, so I'm showing that we received the claim.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] The claim number is 3,556,150.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK. Uh, can you please verify whether you have received the primary UB, uh, from our end, uh, it was submitted on.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] No, we haven't received um the documents yet, um but if you like to resubmit them, you can, but we haven't received them.
[CUSTOMER][POSITIVE] Yeah, OK. Thank you for this information. Uh,
[CUSTOMER][NEUTRAL] Can you please provide me the uh fax number?
[AGENT][NEUTRAL] Sure, fax number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the attention to?
[AGENT][NEUTRAL] Attention APL claims department.
[CUSTOMER][NEUTRAL] And the timely filing limit?
[AGENT][NEUTRAL] So there's no timely filing as long as the policy was active on the data service?
[CUSTOMER][NEUTRAL] And can you please provide me the call reference number for this call?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date. The first initial of my last name is [PII].
[CUSTOMER][POSITIVE] Thank you for your assistance. Have a great day.
[AGENT][POSITIVE] You're very welcome. Hope. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's it. Thank you.
[AGENT][POSITIVE] Alright, thanks for calling APL bye bye.
[CUSTOMER][NEUTRAL] Bye.