AccountId: 011433970860
ContactId: 64f939ce-7c31-4f64-85ad-e2237929e53b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 219630 ms
Total Talk Time (AGENT): 89572 ms
Total Talk Time (CUSTOMER): 55779 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/2025/02/26/64f939ce-7c31-4f64-85ad-e2237929e53b_20250226T13:55_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] Hey [PII], this is [PII]. How are you?
[AGENT][POSITIVE] I'm doing well how are you?
[CUSTOMER][NEUTRAL] I'm doing good. I'm not sure if I have the right department. I'm calling from the provider's office. I was trying to get a status of the claim.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 2008401
[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] Repeat a cook [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 for the claim you want me to check on?
[CUSTOMER][NEUTRAL] Yes ma'am, data service it is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and the total bill amount?
[CUSTOMER][NEUTRAL] $12,050.60.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yes, ma'am. It's Emery Johns Creek Hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 323.
[AGENT][NEUTRAL] 374 8.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the benefit maximum for the data service has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um so that is the patient's responsibility.
[AGENT][NEUTRAL] Well, we don't determine patient responsibility because we're not a major medical insurance company, um, so it will be whatever your procedures are for outstanding balances or remaining balances.
[AGENT][NEUTRAL] If he, if there's no other insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK and um can I get uh.
[CUSTOMER][NEUTRAL] You'll be faxed over.
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And that should be attention, [PII].
[CUSTOMER][NEUTRAL] Yes ma'am with a C.
[AGENT][NEUTRAL] And that's [PII]?
[CUSTOMER][NEUTRAL] Uh yes, ma'am.
[AGENT][POSITIVE] Alright, well, I'll go ahead and send this explanation of benefits over to you now. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Um, just a call reference number, that's all.
[AGENT][NEUTRAL] OK, 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 and thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.