AccountId: 011433970860
ContactId: 58babec4-7982-4423-8b6e-7b9a5713f8d8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 302470 ms
Total Talk Time (AGENT): 94340 ms
Total Talk Time (CUSTOMER): 87869 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/58babec4-7982-4423-8b6e-7b9a5713f8d8_20250508T13:40_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]. This is [PII] calling from provider office to check the claim status.
[AGENT][NEUTRAL] OK, well, I'll be more than happy to help you with the claim status, [PII]. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Monthly.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes. Yes, it will be [PII] and that's a direct line.
[CUSTOMER][NEUTRAL] And member ID will be 021.
[CUSTOMER][NEUTRAL] 201
[CUSTOMER][NEUTRAL] 27
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and date of birth will be [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] It will be [PII] and total bill amount on the claim will be, OK, the date range [PII] [PII]. And total bill amount on the claim will be $584 even.
[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] OK.
[CUSTOMER][NEUTRAL] Yes, provide the office will be Gardens ID group.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] So I'm trying to received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 355.
[AGENT][NEUTRAL] 1223.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the inpatient benefit for the calendar year has been met.
[AGENT][NEUTRAL] So this policy has an inpatient calendar year max of $1500. So that denial is saying by the time this claim came in, the insured had to use the full $1500 so there was nothing else for us to pay out on.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Oh, I'm sorry, I'm sorry, I was on mute. Uh, it's 1500, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Yes, that's
[CUSTOMER][NEUTRAL] And can you check the member have another insurance apart from the uh American public?
[AGENT][NEUTRAL] Um, well, they have their primary insurance because we're secondary, so they have their primary UnitedHealthcare.
[CUSTOMER][NEUTRAL] Yes, apart from UFC any anything?
[AGENT][NEUTRAL] No, we only know of these two policies. Um, if they have others, you have to reach out to the member to confirm.
[CUSTOMER][NEUTRAL] OK. Uh, no problem. First name and first name last name is?
[AGENT][NEUTRAL] Um, it's [PII].
[CUSTOMER][NEUTRAL] Um, it's [PII].
[CUSTOMER][NEUTRAL] First name will be?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and uh, uh call reference number will be?
[AGENT][NEUTRAL] There's no call reference number, but you can use my name and today's date.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thank you so much for call system. You have not be for one claim. Bye-bye. Have a great day ahead and enjoy the rest of your shift.
[AGENT][NEUTRAL] You're welcome, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][NEGATIVE] See, I'm not gonna
[CUSTOMER][NEUTRAL] No, just the one claim. Bye-bye.
[AGENT][POSITIVE] Alright thanks
[AGENT][POSITIVE] Thanks for calling APO bye bye.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.