AccountId: 011433970860
ContactId: 68d1e44b-fc76-48dc-bcd5-089c72161e20
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 460059 ms
Total Talk Time (AGENT): 144182 ms
Total Talk Time (CUSTOMER): 103634 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/68d1e44b-fc76-48dc-bcd5-089c72161e20_20250203T17:34_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, my name is [PII]. I'm calling from provider's office and I'm looking for the claim status.
[AGENT][NEUTRAL] OK, I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] [PII]. What's your name?
[AGENT][NEUTRAL] My name is [PII]. Can you spell your name for me, please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure. My name is [PII].
[AGENT][NEUTRAL] I'm sorry, I'm still not understanding it. Can you spell your name for me, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, see you. Thank you. And your callback number?
[CUSTOMER][NEUTRAL] It's [PII] number [PII].
[AGENT][NEUTRAL] Thank you, and you have one claim, see to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yes, I have one claim to check status.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, I can help you with that. And what is your um patient's policy number?
[CUSTOMER][NEUTRAL] The policy number is 01845704 M as in Mary, L as in Lima 8.
[AGENT][POSITIVE] Thank you. One moment, please.
[AGENT][NEUTRAL] And see, any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII] so date of birth this month, [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and again, see any information that is provided would be a verification of benefits and not a guarantee of payment. What is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] [PII] with the bill amount of $4,0006 you want.
[AGENT][NEUTRAL] And you said the date of service is [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yes, yes, you've got, you got it right.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][POSITIVE] So, welcome.
[AGENT][NEUTRAL] OK. So see, this claim was received on 10-11-2023 and it was processed and denied on 10-13-2023.
[CUSTOMER][NEUTRAL] And I as in
[AGENT][NEUTRAL] The claim number is 3367956.
[AGENT][NEUTRAL] And the reason for the denial states outpatient benefit for this calendar year has been met.
[AGENT][NEUTRAL] And see it
[CUSTOMER][NEUTRAL] And met on which date?
[AGENT][NEUTRAL] It was met on a claim with a claim received prior to this claim.
[CUSTOMER][NEUTRAL] Can you just let me know the date, please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And uh so uh uh can you just send me the UB25?
[AGENT][NEUTRAL] Can you, do you have the ability to access the internet because you can print it directly from our portal by using the claim number that I provided for you.
[CUSTOMER][NEGATIVE] Um, I have checked on the, but, uh, I'm unable to download the EU. That's why I have called.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Mhm. You're welcome.
[AGENT][NEUTRAL] It's gonna take a moment to see you for this information to load.
[CUSTOMER][POSITIVE] No issues. Take your time. And uh meanwhile, can you just provide me the call reference number also?
[AGENT][NEUTRAL] It would be my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] Oh, thank you so much, [PII].
[AGENT][NEUTRAL] You're welcome. So just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And does the fax need to have your name on it also, Sia, or is that not necessary?
[CUSTOMER][NEUTRAL] Uh, you have to, to add my name on that.
[AGENT][NEUTRAL] It does need to have your name on it?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] It's still trying to load it here.
[CUSTOMER][POSITIVE] No issues. Take your time.
[AGENT][NEUTRAL] And what is your fax number please, [PII]?
[CUSTOMER][NEUTRAL] Yeah, just a minute. It's [PII].
[AGENT][NEUTRAL] OK, and I'm gonna repeat that back to you. [PII]. Is that correct?
[CUSTOMER][POSITIVE] Yes. Yes, you are correct.
[AGENT][POSITIVE] OK. So I have just faxed that explanation of benefits to you, so provided that there's not any type of problem with uh transmitting it, you should be receiving that very shortly.
[CUSTOMER][POSITIVE] Thank you so much. Have a nice day, bye-bye the choice from my side. Thank you.
[AGENT][POSITIVE] You're very welcome. Yes, ma'am.