AccountId: 011433970860
ContactId: 98e8b424-ca5d-48ea-b7b0-88011add43d6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 319000 ms
Total Talk Time (AGENT): 162922 ms
Total Talk Time (CUSTOMER): 65226 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/98e8b424-ca5d-48ea-b7b0-88011add43d6_20250214T14:27_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] Hi [PII], this is [PII] with TJ Simpson Community Hospital, and I need to check status of a claim, please.
[AGENT][POSITIVE] Alright, I'll be more than happy to help you with the claim status and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02567172
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] Um, I actually have, let's see.
[CUSTOMER][NEUTRAL] Um, 2 different bill amounts if that's OK.
[AGENT][NEUTRAL] OK, mhm, that's fine.
[CUSTOMER][NEUTRAL] The first one is $1,998.
[CUSTOMER][NEUTRAL] And the second one is $30.
[AGENT][NEUTRAL] OK. And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] TJ Sampson Community Hospital.
[AGENT][NEUTRAL] OK, 231.
[AGENT][NEUTRAL] Alright, so for the $1,998 claim, I'm showing you received it on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And all the information provided is a verification of benefits, not a guarantee of payment.
[AGENT][NEUTRAL] Um, the claim number is 354.
[AGENT][NEUTRAL] 923 1.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome, and on [PII], we paid out on the claim to the provider.
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] A total of $50.
[CUSTOMER][NEUTRAL] Um, what date was that paid again? I'm sorry.
[AGENT][NEUTRAL] Let's see, hold on one moment.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. Did you need that check information?
[CUSTOMER][NEUTRAL] Uh, yes, please.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so it's a single check?
[AGENT][NEUTRAL] In the amount of $50.
[AGENT][NEUTRAL] It was issued on [PII].
[AGENT][POSITIVE] And I'm still showing that it's outstanding. Um, it was
[AGENT][NEUTRAL] Mail to [PII].
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, so I'll resend this to um our representative so that she can check on the check. If it has been cleared, we'll provide you with a copy of the clear check. If not, um, we'll go ahead and reissue it for you cause it's been over 30 days.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome, and let me check on the 2nd 1.
[AGENT][NEUTRAL] OK, so for the $30 payment, we received that on [PII]?
[AGENT][NEUTRAL] That claim number is 355.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 1585.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the maximum benefit for the data service has been met.
[CUSTOMER][POSITIVE] All right, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Has the EOB been sent for that one?
[AGENT][NEUTRAL] Yes, but I can fax you a copy if you need it.
[CUSTOMER][NEUTRAL] OK, yes, please.
[AGENT][NEUTRAL] OK, and what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And should I put attention, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And that's [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, so I'll go ahead and send um the request for the check over and I'm sending you the explanation of benefits, did you need the, the explanation of benefits for both claims or just the second one?
[CUSTOMER][NEUTRAL] Just the second one just in case you all read the check. I don't want to have to, I don't want it to get confusing for everybody.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right, well, I'll go ahead and send this over to you now, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Um, do you have a call reference number?
[AGENT][NEUTRAL] Sure, sir, there's no call reference number, but you can use my name in today's date, and that's [PII], and today's date.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. I hope you have a great weekend.
[CUSTOMER][NEUTRAL] You
[AGENT][POSITIVE] Thank you. Bye-bye.