AccountId: 011433970860
ContactId: 59bab3cd-95de-47da-98c3-f8f3f65603df
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 338649 ms
Total Talk Time (AGENT): 159521 ms
Total Talk Time (CUSTOMER): 84315 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/59bab3cd-95de-47da-98c3-f8f3f65603df_20250304T15:05_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] at Scotland Memorial Hospital. Um, I was calling to check on the status of the claim.
[AGENT][NEUTRAL] OK. Oh well, you're needing to check status on one claim, is that correct?
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] D as in David 42510668.
[AGENT][NEUTRAL] OK, thank you, but oh, that is not an APO policy number. That is a 90 degree policy number. Were you trying to reach 90 degrees?
[CUSTOMER][NEUTRAL] Um, give me one second.
[AGENT][NEUTRAL] Sure. Some of these people, some of the members have, yeah, dual policies. No, that's OK. Some of them have uh dual policies with 90 degrees and APL, but not all. So that's why I was wondering because I know if you call 90 degrees phone number, depending on what option you choose, it will bring you to APL so that's why I was asking that.
[CUSTOMER][NEUTRAL] Cause the
[CUSTOMER][NEUTRAL] Oh, policy number, OK.
[CUSTOMER][NEGATIVE] Oh sorry.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, well
[CUSTOMER][NEUTRAL] Well, the, the card he gave us, it has APL on it, but then it has like a policy certificate and then a medical ID number, so the policy certificate number is um 02505206.
[AGENT][NEUTRAL] Hi.
[AGENT][NEUTRAL] OK, thank you. So one moment, please.
[AGENT][NEUTRAL] And again you did say you were needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and I'll let any information that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII], uh, date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And the date of service and total bill amount for him, please.
[CUSTOMER][NEUTRAL] Data service was [PII]. Total charges were $2,049.75.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so this claim was received, the claim number is going to be 3555.
[AGENT][NEUTRAL] 328.
[AGENT][NEGATIVE] And this was denied for this charge.
[AGENT][NEUTRAL] And the reason for the denial, give me just one moment and I'll read that to you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] If I can work my fingers correctly, I will read this to you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If during this hospital confinement you required services of a physician other than a surgeon, please submit the itemized bill for review.
[CUSTOMER][NEUTRAL] Mm, other than a surgeon, OK, um, so can I, can I fax the detailed bill or?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes ma'am, you can, and that can be faxed to attention claims.
[AGENT][NEUTRAL] And the fax number that it would be sent to is [PII].
[AGENT][NEUTRAL] And then once, mhm, yes, ma'am, and we also have a portal or if you need a copy of this explanation of benefits, you should be able to get that from the portal by going to [PII].
[CUSTOMER][NEUTRAL] OK attention.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and um, also can you uh verify that his coverage was active on this data service as well?
[AGENT][NEUTRAL] Yes, ma'am. It does show that it was active. The policy had an effective date is [PII].
[CUSTOMER][NEUTRAL] OK, and can I get a uh reference number for the phone call?
[AGENT][NEUTRAL] Sure, you would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] Well, you are certainly very welcome. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, ma'am, that was it.
[AGENT][POSITIVE] OK. Well, thank you again for calling APLO and I hope you, hope you have a very nice and safe day.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Mhm bye.