AccountId: 011433970860
ContactId: 800b5fda-b837-406e-aed9-86b915d7d4a3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 355260 ms
Total Talk Time (AGENT): 138200 ms
Total Talk Time (CUSTOMER): 104663 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/800b5fda-b837-406e-aed9-86b915d7d4a3_20250128T15:02_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling you from provider's office, checking on claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status, and [PII], how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Two claims
[AGENT][NEUTRAL] And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 01887317 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, my first name is [PII] and the last name is [PII] 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 for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] total charge $599 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Holy Cross Medical Group.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] You, you need the individual provider name?
[AGENT][NEUTRAL] No, I'm OK. Just the facility.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And I am showing that we received the claim. Hold on one moment, it's going back on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3549504.
[AGENT][NEUTRAL] And on [PII], the claim was denied as office visits are not covered by this um policy.
[CUSTOMER][NEUTRAL] OK, office visits are not covered.
[CUSTOMER][NEUTRAL] OK, just to confirm, the claim number is 35495004. I'm right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. Can we check for the next number?
[AGENT][NEUTRAL] Sure, hold on one moment, let me note this policy.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] 02287960. M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, my first name is [PII] and the last name is [PII] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Yeah, date of services [PII] total charge $1,803 even.
[AGENT][NEUTRAL] Thank you. And again, all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment while I locate the claim.
[AGENT][NEUTRAL] And is it the same provider on this claim as well, or would it be a different provider?
[CUSTOMER][NEUTRAL] Uh, same provider.
[AGENT][NEUTRAL] OK, so we received this twice. OK, so we, the last time we received the claim was [PII]. I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That claim number is 3553552.
[AGENT][NEUTRAL] And also on [PII], we paid out on the claim um a single check in the amount of $75.
[AGENT][NEUTRAL] And did you need that check information?
[CUSTOMER][NEUTRAL] Yeah, you have allowed $75 and paid $75. Am I right?
[AGENT][NEUTRAL] $75 is the allowed amount for the benefit that was used and it was paid in full.
[CUSTOMER][NEUTRAL] OK. And can I get the check number?
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] 367 2.
[CUSTOMER][NEUTRAL] 72. OK. And when was the check issued?
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] OK. Can you please verify me the uh check pay to address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Correct. This one was a single check or bulk check?
[AGENT][NEUTRAL] It was a single check in the amount of $75.
[CUSTOMER][NEUTRAL] OK. And may I have your name spelled, please?
[AGENT][NEUTRAL] Yes, my name is [PII].
[CUSTOMER][POSITIVE] OK, sure, [PII], it was great speaking with you. Have a good day. Bye-bye.
[AGENT][POSITIVE] You also and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.