AccountId: 011433970860
ContactId: a3fbea36-42bf-43c7-b060-c5ebe746b74b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 343549 ms
Total Talk Time (AGENT): 109013 ms
Total Talk Time (CUSTOMER): 184054 ms
Interruptions: 7
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/a3fbea36-42bf-43c7-b060-c5ebe746b74b_20250508T13:27_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] Yeah, hi, my name is [PII]. My last initial is [PII] calling for claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status, [PII]. And how many claims do you have in total today?
[CUSTOMER][POSITIVE] I'm happy to assist you with the claim status, [PII]. And how many claims do you have in total today? Uh, only one claim.
[AGENT][NEUTRAL] Alright, and may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Alright, and may I have a good contact number in case we
[CUSTOMER][NEUTRAL] The policy number. My contact number is [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you for that. And the member's policy number?
[CUSTOMER][POSITIVE] Thank you for that.
[CUSTOMER][NEUTRAL] And the member's policy number? Sure. The member's policy number is
[CUSTOMER][NEUTRAL] 02544110.
[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] Verify the member's first and last name and date of birth. The member's name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you for that. And all the information provided is a verification of benefits and a guarantee of payment.
[CUSTOMER][POSITIVE] Thank you for that. And all the information provided is a verification of benefits and a guarantee of payment.
[AGENT][NEUTRAL] And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] And may I have the date of service and the total bills for the claim? The date of service is [PII] and the total bill amount is $38 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] And that was [PII] [PII].
[AGENT][NEUTRAL] [PII]. OK, hold on one moment.
[CUSTOMER][NEUTRAL] [PII] OK hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] And can you verify the name of the provider's office on the claim? Medical University Hospital, MUSC.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And are you needing the original claim or the duplicate?
[CUSTOMER][NEUTRAL] And now you needed the original claim or the duplicate? Uh, what is this?
[AGENT][NEUTRAL] Alright, so we received the claim on [PII].
[CUSTOMER][NEUTRAL] Alright, so we received the claim on [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] The claim number
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The claim number
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3581566.
[CUSTOMER][NEUTRAL] Claim number is 3581566.
[AGENT][NEUTRAL] And on [PII], the claim was denied, requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] And on [PII] this claim was denied requesting an explanation of benefits from primary insurance. OK. May I know who is primary for this member?
[AGENT][NEUTRAL] Sure, hold on one moment.
[CUSTOMER][NEUTRAL] Sure, one moment.
[AGENT][NEUTRAL] So I'm showing as Blue Cross Blue Shield of South Carolina?
[CUSTOMER][NEUTRAL] I'm showing as Blue Cross Blue Shield of South [PII].
[CUSTOMER][NEUTRAL] OK, and may I know the call reference number for the conversation?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. My last name is [PII].
[CUSTOMER][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date. My last name is [PII]. OK, and I could see that uh we have [PII] as a primary for this member sorry, secondary for this member and American public life is primary for this member will you send this claim back for reprocessing? OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I will be able to send this claim back for reprocessing.
[AGENT][NEUTRAL] No, because that information is incorrect. We are not affiliated with Ambetter. We are second only to Blue Cross Blue Shield of [PII].
[CUSTOMER][NEUTRAL] No, because that information is incorrect. We are not affiliated with Abetter. We are second only to Blue Cross Blue Shield of [PII].
[AGENT][NEUTRAL] And we process this claim a second, which is why we're
[CUSTOMER][NEUTRAL] Uh, so. And we process this claim a second, which is why we're requesting the explanation of benefits for primary.
[AGENT][NEUTRAL] Requesting the explanation of benefits for primary.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] In this case, uh,
[CUSTOMER][NEUTRAL] You'll be able to send the DMB copy to my fax number.
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Sure, what's a good fax number for you? It's [PII].
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] The fax and the phone number are the same?
[CUSTOMER][NEUTRAL] The fax and the phone number are the same? Oh, sorry, sorry for that, the fax number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] [PII]. Yes, correct.
[AGENT][NEUTRAL] And that's Mike, [PII] [PII] [PII]?
[CUSTOMER][NEUTRAL] That's [PII]. Yes, correct.
[AGENT][NEUTRAL] OK, well, I'll go ahead and send this over to you now. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Over to you now.
[CUSTOMER][POSITIVE] I can help you with today? No, I complete all my claims.
[AGENT][POSITIVE] Alrighty, well, thank you so much for calling APL [PII]. I hope you have a great day.
[CUSTOMER][POSITIVE] Well thank you
[CUSTOMER][POSITIVE] Yeah you have a great day too bye.
[AGENT][POSITIVE] Thank you. Bye bye.