AccountId: 011433970860
ContactId: 8ea671c6-341a-4218-8afe-7160247e97ef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 297399 ms
Total Talk Time (AGENT): 162111 ms
Total Talk Time (CUSTOMER): 68902 ms
Interruptions: 3
Overall Sentiment: AGENT=1.1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/8ea671c6-341a-4218-8afe-7160247e97ef_20250530T14:27_UTC.wav
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[AGENT][NEUTRAL] Morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling from SSM Health. I have a claim to check status on.
[AGENT][NEUTRAL] OK, so you're needing to check claim status for one member, is that correct, ma'am?
[CUSTOMER][NEUTRAL] Yes it is.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] 02117282
[AGENT][NEUTRAL] OK Pa thank you one moment.
[AGENT][NEUTRAL] And any information [PII] that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I'm so sorry, did you say that you're gonna need eligibility and benefits or just eligibility for him, [PII]?
[CUSTOMER][NEUTRAL] Uh, just claim status.
[AGENT][POSITIVE] Oh, I'm so neither. See, I totally got that wrong. Long week. I'm so sorry. My short-term memory is, is about depleted, um, I believe, according to that remark that I just made.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][POSITIVE] It's, it's all right.
[CUSTOMER][NEUTRAL] It happens.
[AGENT][NEUTRAL] OK, and so, um, again, any information provided is a verification of benefits and not a guarantee of payment, what is the date of service and total bill amount that you're calling about?
[CUSTOMER][NEUTRAL] 1919 to 125 $2025187,444.28.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so that was 19 to 128. Is that correct?
[CUSTOMER][NEUTRAL] 125.
[AGENT][NEUTRAL] 0, 125. I guess my hearing is going as well.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then the total bill amount one more time, 187,000.
[CUSTOMER][NEUTRAL] Uh-huh, $444.28.
[AGENT][NEUTRAL] Mhm. 18. OK, thank you.
[CUSTOMER][NEUTRAL] Yes. Mhm.
[AGENT][NEUTRAL] So excuse me. So this claim was received, [PII], and it was received on [PII].
[AGENT][NEUTRAL] Processed and denied on [PII]. The claim number is 3593327.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the reason for the denial is that we are in need of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK, would I be able to fax that?
[AGENT][NEUTRAL] Yes, [PII], you can. The claims fax number is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] My goodness, um, a number that I give all day long. I don't know what's going on with me at the moment, [PII], I'm so sorry. It's 1-8773659423. Attention claims department.
[CUSTOMER][NEUTRAL] It's Friday.
[AGENT][NEUTRAL] And if you need a copy, uh-huh, of this explanation of benefits now that you have the claim number you should be able to print that if you go to our portal which is located at [PII].
[CUSTOMER][NEUTRAL] Attention [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Yes, make sure to put a [PII] after the words [PII].
[CUSTOMER][POSITIVE] OK, [PII].
[CUSTOMER][NEUTRAL] OK, alright, and do you have a call reference number?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, and you will actually use my name along with today's date.
[CUSTOMER][POSITIVE] All right, thank you very much have a great day.
[AGENT][POSITIVE] Well, you are certainly very welcome and if that is all I can help you with, thank you again for calling APL payment and I hope you have a great day also.
[CUSTOMER][POSITIVE] Thank you. Bye bye.
[AGENT][NEUTRAL] OK. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.