AccountId: 011433970860
ContactId: 846ecd42-01a1-41b8-a098-29e9d857232c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 332720 ms
Total Talk Time (AGENT): 145712 ms
Total Talk Time (CUSTOMER): 90900 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/846ecd42-01a1-41b8-a098-29e9d857232c_20250312T14:50_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, good morning [PII]. I would like to check the claim status.
[AGENT][NEUTRAL] OK, you're needing claim status, is that correct?
[CUSTOMER][POSITIVE] Yes please.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that and who am I speaking with?
[CUSTOMER][NEUTRAL] With [PII]
[AGENT][POSITIVE] I'm so sorry.
[CUSTOMER][NEUTRAL] From vital imaging.
[AGENT][NEUTRAL] What is your name again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK, thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] The patient name sorry?
[AGENT][NEUTRAL] No, the patient's policy number.
[CUSTOMER][NEUTRAL] OK, the patient policy number is gonna be 02.
[CUSTOMER][NEUTRAL] 518924
[AGENT][POSITIVE] OK, thank you. Give me a couple of moments please, [PII] to get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] [PII], any information that I provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] And the patient name?
[CUSTOMER][NEUTRAL] The patient name is [PII].
[AGENT][NEUTRAL] And the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] was in [PII].
[CUSTOMER][NEUTRAL] For the, let me check one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] $2400.
[AGENT][NEUTRAL] 2400. Is that correct?
[CUSTOMER][NEUTRAL] That's right, mhm.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEGATIVE] OK, [PII], so this claim has been received multiple times. The last 2 times it was received, it was denied as a duplicate. Do you need the original claim information?
[CUSTOMER][NEUTRAL] OK, that's the reason that I saw here that it was duplicated, but I would like to know the check amount.
[CUSTOMER][NEUTRAL] The check number please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, there is no check number. The initial claim number is 3557596.
[AGENT][NEUTRAL] And this claim was denied. The reason for the denial on the claim, [PII] states that.
[AGENT][NEUTRAL] Receipt of the excuse me, let me start over. Receipt of the reference claim is acknowledged. However, in order for us to process this claim, we need the explanation of benefits that matches the claim information.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I saw in the system that we send that a lot many times.
[CUSTOMER][NEUTRAL] Mm let me check.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] So you need the explanation of benefit?
[AGENT][NEUTRAL] That matches the claims information. Yes, ma'am.
[CUSTOMER][NEUTRAL] The matches when the claim formation.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEGATIVE] We received an explanation of benefits but it did not match the claims information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I'm gonna send it again. OK, OK, thank you.
[AGENT][NEUTRAL] OK, so we just need the explanation of benefits. You do not have to resubmit the claim form. We just need the explanation of benefits and you can reference that claim number that I just provided for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then um also [PII], once the claim has been reviewed by APL, we do have a portal in which you can check claim status also, and our portal website for that is [PII].
[CUSTOMER][POSITIVE] OK thanks.
[AGENT][NEUTRAL] OK. Well, is there anything else that I can help you with at the moment?
[CUSTOMER][NEUTRAL] No thank you thank you have a great day.
[AGENT][POSITIVE] OK, well, you're very welcome, [PII]. Yes, ma'am and thank you for calling APL. I hope you have a great day as well.
[CUSTOMER][NEUTRAL] Bye bye bye.
[AGENT][NEUTRAL] Bye bye.