AccountId: 011433970860
ContactId: 8722a42e-1763-4e0e-94da-2a70df286434
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 464500 ms
Total Talk Time (AGENT): 142736 ms
Total Talk Time (CUSTOMER): 199694 ms
Interruptions: 5
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/8722a42e-1763-4e0e-94da-2a70df286434_20250417T17:56_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APM. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider office and looking for the claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help 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] Yeah.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Mm yes.
[CUSTOMER][NEUTRAL] The member ID is 023127778.
[CUSTOMER][NEUTRAL] [PII] M as in [PII].
[CUSTOMER][NEUTRAL] I.
[AGENT][POSITIVE] Thank you for that. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Mm, yes, it's uh [PII].
[AGENT][NEUTRAL] I'm sorry, that's the phone number you're giving me?
[CUSTOMER][NEUTRAL] No, no, it's uh NPI.
[AGENT][NEUTRAL] I'm asking for the contact number, the phone number in case we're disconnected.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mm, just a moment. It's uh [PII].
[AGENT][NEUTRAL] Thank you and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] And can you verify the member's first and last, can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] I'm looking for the claim status.
[CUSTOMER][NEUTRAL] Uh yes.
[CUSTOMER][NEUTRAL] The date of birth is [PII] and the patient name is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, wait a minute. What's the date of birth?
[CUSTOMER][NEUTRAL] Date of birth is uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me make sure I have the policy number correct. It's 231277-8.
[CUSTOMER][NEUTRAL] Mm, just a moment and then now, what's the member ID?
[CUSTOMER][NEUTRAL] Maybe what we do.
[AGENT][NEUTRAL] 231-277-8.
[CUSTOMER][NEUTRAL] No, it's uh the number 0.
[AGENT][NEUTRAL] What's the
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The number 02312778. M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] 231-277-8.
[CUSTOMER][NEUTRAL] I'll go.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The reason I'm asking is because when I pull that up, there's a diff there's different members here. I don't see that date of birth at all. What is the member's first name?
[CUSTOMER][NEUTRAL] Check out.
[CUSTOMER][NEUTRAL] it
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so that's the last name. What's the first name?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what date of birth do you have for [PII]?
[CUSTOMER][NEUTRAL] Yes, [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 bills?
[CUSTOMER][NEUTRAL] [PII] and the total bill amount is $911.51.
[AGENT][NEUTRAL] $911.61.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEUTRAL] And that's the total bill?
[CUSTOMER][NEUTRAL] Yes, the total bill amount is, yes.
[AGENT][NEUTRAL] Is that correct?
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] I you
[CUSTOMER][NEUTRAL] I got me that they had a big card right now.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] You you.
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What's your tax ID?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Your tax ID is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So we have claims on file for that data service from your provider, but it's not this total bill of 9/1161. Are there any other total bills that it could be?
[CUSTOMER][NEUTRAL] Not so 6151.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] 911 $11.51.
[AGENT][NEUTRAL] OK, so it's 51, but still there's no total bill for your amount from your provider. Is there a different total bill that it could be?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I'm not talking.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I'm here.
[AGENT][NEUTRAL] I'm asking you if the 9/11, $11.51 is this the only total that is for your claim? Because there's 3 claims that was received for your date of service, but they're all over.
[CUSTOMER][NEUTRAL] Let me check. Just a, let me check, just a moment.
[AGENT][POSITIVE] $1000. Thank you.
[CUSTOMER][NEUTRAL] Double checking.
[CUSTOMER][NEUTRAL] Sorry, it's the total amount is $3200.
[AGENT][NEUTRAL] 3200.
[CUSTOMER][NEUTRAL] $3200 even.
[AGENT][NEUTRAL] Alright, so we received that claim on [PII].
[AGENT][NEUTRAL] The claim number is 356.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 7966.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] It's like
[AGENT][NEUTRAL] Because the maximum benefit payable for the date of service has been met.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mm, denied reason, uh, what is the denied reason?
[AGENT][NEUTRAL] The maximum
[CUSTOMER][NEUTRAL] Well, I