AccountId: 011433970860
ContactId: 64e260cd-27e0-4b9c-954a-7b67c7c4c121
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 473100 ms
Total Talk Time (AGENT): 186050 ms
Total Talk Time (CUSTOMER): 92654 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/64e260cd-27e0-4b9c-954a-7b67c7c4c121_20250618T15:54_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], excuse me, my name is [PII] and I'm calling from Dell Clinic. Want to see if y'all had a couple of claims on file and if so what their status is.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Absolutely it's [PII] and that's a direct line with secure voicemail.
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Um, I have two claims for the same patient.
[AGENT][NEUTRAL] OK, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am, it is.
[CUSTOMER][NEUTRAL] 02492221 ML 7
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], 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. And you can give me uh the, if you like all at once, the dates of service and the total bills.
[CUSTOMER][NEUTRAL] Alright, the first one is 1202025 for $7,248.
[CUSTOMER][NEUTRAL] And let me pull this other one up.
[CUSTOMER][NEUTRAL] And the other one is also 1202025 for $1,116.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII], is it alright if I place you on just a brief hold while I look for the the claim?
[CUSTOMER][POSITIVE] Oh yes ma'am, no problem.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] [PII]. OK, [PII], 36008. 3610616.
[AGENT][NEUTRAL] Amtrak 356.
[AGENT][NEUTRAL] CLMR.
[AGENT][NEUTRAL] 390.
[AGENT][NEUTRAL] Yeah uh
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] That's why I check everything.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII]?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait. So, for the um $7,248 total bills, that, did you want the original claim or the pay claim? The original was denied uh needing the explanation of benefits and then y'all sent it in.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, I need a paid one.
[AGENT][NEUTRAL] The paid one? OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So the paid one was received on [PII].
[AGENT][NEUTRAL] Claim number is 361.
[AGENT][NEUTRAL] 0616.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And on [PII], the claim um we paid out on a total of $5,791.64.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you need that check information?
[CUSTOMER][NEUTRAL] If you have it, yes, ma'am.
[AGENT][NEUTRAL] Sure, hold on one moment.
[AGENT][NEUTRAL] So it was a single check?
[AGENT][NEUTRAL] Um, check number 2049074.
[AGENT][NEUTRAL] And it was issued on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, is there any patient responsibility on that one?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] So for medical, we don't determine patient responsibility because we're not the major medical insurance company.
[AGENT][NEUTRAL] Um, but from what it
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] From what it looks like we were billed 5791 and we paid that full amount.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the other claim, um, $1,116 that claim was received, well, hold on, that might be the same thing. Wait a minute.
[AGENT][NEUTRAL] Nope. OK, we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this claim was denied because the um requesting an explanation of benefits from primary insurance?
[CUSTOMER][NEUTRAL] OK, they didn't send it on that one either, OK.
[AGENT][NEUTRAL] No, ma'am. The claim number is 3604356.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, I'll fax that over. Can you give me that fax number?
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Alright, I'll need to call reference and then I'll get that over to you.
[AGENT][NEUTRAL] Alright, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Alright thank you so much, [PII]. You have a great rest of your day.
[AGENT][NEUTRAL] You also, [PII], was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] No, ma'am, that is it.
[AGENT][POSITIVE] All right, thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Bye bye