AccountId: 011433970860
ContactId: 7ee9f2ae-5ffa-4b1e-94d1-08d7c40cf577
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 335899 ms
Total Talk Time (AGENT): 121606 ms
Total Talk Time (CUSTOMER): 70363 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/7ee9f2ae-5ffa-4b1e-94d1-08d7c40cf577_20250421T13:12_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] Uh, hi, my name is [PII]. I'm calling from Florida's office. I need to check on the claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status, [PII]. May I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] Oh yeah, sure.
[CUSTOMER][NEUTRAL] My contact number is [PII], and it's a direct line and the patient's policy ID is 01912860M as in Mike L as in Lima 7.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And how many claims do you have in total today, [PII]?
[CUSTOMER][NEUTRAL] Just one.
[AGENT][NEUTRAL] OK, may I have the member's policy number?
[AGENT][NEUTRAL] I'm sorry, the, I said that wrong. I'm sorry. Can you verify the member's first and last name and date of birth? I was looking at the policy number, sorry.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh yeah, sure. And the complete name is [PII] and the 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 may I have the date of service and the total bill for the claim you like me to go over with you?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the bill amount is $5,279.15.
[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] Oh yeah, the name of the provider is at [PII] Orlando.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] So I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 355.
[AGENT][NEUTRAL] 873 2.
[AGENT][NEUTRAL] And on [PII].
[AGENT][NEUTRAL] Um, the claim was denied.
[AGENT][NEUTRAL] But all the payable benefits for this charge were applied to the policy's emergency room deductible.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] This deductible is assessed for treatment of a sickness provided in the hospital emergency room. So it was denied, but it was paid to the deductible.
[CUSTOMER][NEUTRAL] OK, so it was applied as deductible, OK?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And how much is that deductible amount?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Hold on one moment, [PII].
[AGENT][NEUTRAL] I'm waiting for the benefits to come up here. The emergency room deductible is $100.
[CUSTOMER][NEUTRAL] Can you please fax the EOB?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] The fax number is
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And should I put attention to [PII]?
[CUSTOMER][NEUTRAL] And can you
[CUSTOMER][NEUTRAL] Oh yeah, [PII], the last name initial is.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That was [PII]?
[CUSTOMER][NEUTRAL] Can you repeat that once again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Oh yeah, that's correct.
[AGENT][NEUTRAL] OK, so I'm sending this to you now. Hold on one moment.
[AGENT][NEUTRAL] Alright, so the fax is on its way to you. Was there anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] Um, and we can expect to receive this fas.
[AGENT][POSITIVE] For a fact, we um at least give it an hour. If you have not received it by the end of day today, um you can definitely give us a call back and we'll be more than happy to resend it for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] May I know your last name?
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] Can I have a call reference?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date.
[CUSTOMER][POSITIVE] OK, then thank you so much for all the information. You have a great day ahead.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. I hope you have a great day also. Bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.