AccountId: 011433970860
ContactId: 8ae7db77-81d9-41a0-b768-f92193ee6f4a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 400660 ms
Total Talk Time (AGENT): 162260 ms
Total Talk Time (CUSTOMER): 115646 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/8ae7db77-81d9-41a0-b768-f92193ee6f4a_20250103T15:54_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] Yeah, hi [PII], my name is [PII] calling from office.
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Checking up on claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII], and how many claims do you have today in total?
[CUSTOMER][NEUTRAL] Only one, and my name is [PII].
[AGENT][NEUTRAL] [PII]. OK, sorry about that. And [PII], may I have a good contact number in case we're disconnected in the policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yes, my callback number would be [PII].
[CUSTOMER][NEUTRAL] And policy number of the patient is 02137808.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And [PII], can you verify
[CUSTOMER][NEUTRAL] And, and I can I get your
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] No, it's OK. Go ahead. The initial to my last name?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It's [PII],
[CUSTOMER][POSITIVE] Awesome.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[CUSTOMER][NEUTRAL] His 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. May I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Yes, I'm checking for [PII] with the total charge amount of $346.80.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, so we received this claim quite a few times. Are you wanting the original claim status?
[CUSTOMER][NEUTRAL] It's the original one?
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Hold on one second.
[AGENT][NEUTRAL] OK, so I'm showing, well, first, can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] 2 Regional Healthcare.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm showing that we originally received the claim on [PII].
[AGENT][NEUTRAL] And that claim number is 327.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0828
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance.
[AGENT][NEUTRAL] And then we received it again.
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That claim number is 352.
[AGENT][NEUTRAL] 4920.
[CUSTOMER][NEUTRAL] Uh, I'm sorry, your voice is, uh. Can you please repeat a more time? The number is 352.
[AGENT][NEUTRAL] Sure. 352-492-0.
[CUSTOMER][NEUTRAL] OK, and uh what is the status for this one?
[AGENT][NEUTRAL] So on [PII], the claim was denied. Oh, you know what, hold on one second. Yeah, the claim was denied because the insured's primary insurance provided full benefits, so there are no benefits payable.
[CUSTOMER][NEUTRAL] OK, you're saying um um member I already paid the amount uh.
[CUSTOMER][NEUTRAL] On in full so you're not able to.
[CUSTOMER][NEUTRAL] Pay the amount of.
[AGENT][NEUTRAL] Right, so from the explanation of benefits that we received, it showed that primary insurance paid the full amount, so there was nothing else to pay.
[CUSTOMER][NEUTRAL] OK, can I get the date on this claim?
[AGENT][NEUTRAL] Yes, hold on one second.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and just to verify the number you gave me is 3,543,524,920.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello, I'm saying, uh.
[CUSTOMER][NEUTRAL] The number I have is 352-492-0, is it right?
[AGENT][POSITIVE] Yes, that's correct for the 2nd claim that came in.
[CUSTOMER][NEUTRAL] OK, I can claim, yeah, and also I don't have any copy of EOB for the recent one.
[AGENT][POSITIVE] Sure, I can fax it to you.
[CUSTOMER][NEUTRAL] Which is dinner, yeah.
[AGENT][NEUTRAL] What's a good fax number for you?
[CUSTOMER][POSITIVE] Yeah, I appreciate that.
[CUSTOMER][NEUTRAL] Yes, my fax number would be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do I need to put attention, [PII]?
[CUSTOMER][NEUTRAL] Yes, you can put my name to attention.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Alright, well, I will go ahead and send this over to you now, [PII]. So you just need the second one or you want, you want both of them? I can send you both if you like.
[CUSTOMER][NEUTRAL] Um, for the recent one.
[AGENT][NEUTRAL] The most recent one? OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So I'll go ahead and send this um explanation of benefits over to you. Was there anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] No, and actually how long it will take to receive the fax.
[AGENT][NEUTRAL] Well, I just sent it, so I give it at least an hour, but by end of day the most.
[CUSTOMER][POSITIVE] Perfect. And can I get the reference number for our call?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date.
[CUSTOMER][POSITIVE] Thank you so much and uh and that's all for today, yeah.
[AGENT][POSITIVE] Alright, well, thank you so much for calling APL [PII]. I hope you have a great weekend and happy New Year.
[CUSTOMER][POSITIVE] You too. Happy New Year. Have a nice day.
[AGENT][POSITIVE] Thank you. Bye-bye.