AccountId: 011433970860
ContactId: 76a69697-079a-43da-bf1e-6eb76eeaaa9d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 240929 ms
Total Talk Time (AGENT): 78868 ms
Total Talk Time (CUSTOMER): 52662 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/76a69697-079a-43da-bf1e-6eb76eeaaa9d_20250506T12:44_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, this is [PII] calling from provider's office to check the medical 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] Uh, only one claim right now.
[AGENT][NEUTRAL] OK, and may I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, the member's policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] 02564245.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII]. Date of birth, [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 bill for the claim?
[CUSTOMER][NEUTRAL] [PII]. And the total bill amount is 8, just a second.
[CUSTOMER][NEUTRAL] $83,407.96.
[AGENT][NEUTRAL] 83,400.
[CUSTOMER][NEUTRAL] $7.
[CUSTOMER][NEUTRAL] 96 cents.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Um, Doctor Hospital of Augusta.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Alright, so I'm trying to receive the claim on [PII].
[AGENT][NEUTRAL] The claim number is 354.
[AGENT][NEUTRAL] 0438.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the insured's primary provided full benefits, there are no benefits payable.
[CUSTOMER][NEUTRAL] OK, requesting primary insurance?
[AGENT][NEUTRAL] No, the primary insurance has paid the full benefits, so there's nothing left to pay.
[CUSTOMER][NEUTRAL] OK, how much I paid?
[AGENT][NEUTRAL] Um, if the bill is $83,407.96 and they provided full benefits, then it would be the full balance.
[CUSTOMER][NEUTRAL] OK, there's nothing to pay. Is that right? Thank you. Uh, may I know the factor of the MS plan?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Effected date, members plan start date.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, process on. I mean, uh, sorry, uh call reference number?
[AGENT][NEUTRAL] There's no call reference number. You can use my name in today's date and that's [PII].