AccountId: 011433970860
ContactId: 97f65205-4b66-4d23-96b5-a055bf65e455
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 271529 ms
Total Talk Time (AGENT): 136931 ms
Total Talk Time (CUSTOMER): 48998 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/97f65205-4b66-4d23-96b5-a055bf65e455_20250523T12:21_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] Yes my name is [PII] and I'm calling from a provider's office um.
[AGENT][NEUTRAL] Yes I am.
[CUSTOMER][NEUTRAL] Regarding an old claim that's not been paid.
[AGENT][NEUTRAL] OK, are you wanting to check claim status to see if it's been received?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am. I can help you with that, [PII], and what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII] and that's my direct line.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, thank you and what is the member's policy number please?
[CUSTOMER][NEUTRAL] That is 02350172.
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] will be a verification of benefits and not to guarantee your payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] It is [PII], [PII].
[AGENT][NEUTRAL] Thank you and the date of service and total bill amount please.
[CUSTOMER][NEUTRAL] 1119 of 24.
[CUSTOMER][NEUTRAL] Total bill was $243.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So this claim has been received more than once. The most recent claim that was received was a denied of previously submitted expenses. So would you like the original claims information, [PII]?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so let's see.
[AGENT][NEUTRAL] Just pulling up the information.
[AGENT][NEUTRAL] So this claim was initially received on [PII].
[AGENT][NEUTRAL] And processed on [PII]. I was really going back in time there for a second. And it was processed and denied on [PII].
[CUSTOMER][POSITIVE] You're OK.
[AGENT][NEUTRAL] The claim number is 3533579.
[AGENT][NEUTRAL] And the reason for the denial on this claim is that one office visits are not covered by the above numbered policy.
[AGENT][NEUTRAL] And on the other code, it stated outpatient benefit for this calendar year has been met.
[CUSTOMER][NEUTRAL] OK, outpatient.
[AGENT][NEUTRAL] Yes ma'am, and if you need a copy of that explanation of benefits, [PII], you should be able to print that from our portal now that you have the claim number.
[AGENT][NEUTRAL] The website for the portal is located at [PII]. Again, that's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, dear, and do you all do reference numbers?
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] Yes, ma'am, you'll actually use my name along with today's date. Again, my name is [PII].
[AGENT][NEUTRAL] And is there anything else, [PII], I could help you with this morning?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] No, ma'am. I appreciate all your help.
[AGENT][POSITIVE] OK, well thank you so much then for calling APL and I hope you have a wonderful holiday weekend.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.