AccountId: 011433970860
ContactId: 7f6ccbb6-a43f-4aa4-ac06-ed135ea3c713
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 204100 ms
Total Talk Time (AGENT): 73489 ms
Total Talk Time (CUSTOMER): 87411 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/7f6ccbb6-a43f-4aa4-ac06-ed135ea3c713_20250310T19:34_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling from Piedmont Healthcare. I just want to check the status of a patient's claim.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claim status, and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, yes, [PII], that's a direct line.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, um, the policy number that we have is D as in Delta 43728955.
[AGENT][NEUTRAL] And do you have a copy of the member's ID card available?
[CUSTOMER][NEUTRAL] Um, I do not. I just have the patient EOB that I was calling to ask a question about.
[AGENT][NEUTRAL] On the EOB, what is the, um, you have the APL explanation benefits?
[CUSTOMER][NEUTRAL] Yes, ma'am. Oh, I see there OK.
[AGENT][NEUTRAL] OK, what's the policy number on that? Mhm.
[CUSTOMER][NEUTRAL] Yeah, uh, it's 02381439.
[AGENT][NEUTRAL] Thank you, hold on one second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh yes, first name [PII], last name spelled [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 for the claim and the total bill?
[CUSTOMER][NEUTRAL] Uh, [PII] for $17,939.65.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] It is here it is.
[AGENT][NEUTRAL] Alright, so I'm showing that the premium for this day that covers this data service was not received, therefore, no benefits were payable. OK, and what questions did you have about the um claim?
[CUSTOMER][NEUTRAL] Uh, well, basically that's pretty much it. Uh, the EOB stated that that you needed the patient to confirm eligibility. We didn't know if you need additional information, but, um, I mean it did obviously didn't say the premium issue, but I'll go ahead and I'll update that information. We'll try to contact the patient. I don't believe that we'll do a lot, um, with that, but I just wanted to confirm to see what that meant to see if he needed to submit anything if we could reach out to the patient to try to get the claim reprocessed for payment.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alrighty.
[AGENT][NEUTRAL] Well
[CUSTOMER][NEUTRAL] Alright, and uh is there a reference number for our call today?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date again, that's [PII] The [PII] my [PII].
[AGENT][NEUTRAL] And then today's date.
[CUSTOMER][POSITIVE] Alrighty thank you so much I'll update that now.
[AGENT][POSITIVE] You're very welcome. Well, thanks for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][POSITIVE] You're welcome. Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.