AccountId: 011433970860
ContactId: a43aef08-bb98-4a09-836e-c5361e70f60f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 377480 ms
Total Talk Time (AGENT): 126100 ms
Total Talk Time (CUSTOMER): 186636 ms
Interruptions: 6
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/a43aef08-bb98-4a09-836e-c5361e70f60f_20250502T13:17_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] Good morning. Thank you for calling APL. My name is [PII]. How may I help you? Hi, [PII]. This is [PII] calling from provider's office to check on our claim status. How are you doing today?
[AGENT][POSITIVE] I'm doing well, sir. How are you?
[CUSTOMER][POSITIVE] Yeah, I'm good, thank you for asking.
[AGENT][NEUTRAL] You're welcome, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII] direct line no extension.
[AGENT][NEUTRAL] Thank you. May I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] The member policy ID is 02260096.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. The patient's name is [PII] and the 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. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Thank you for that and all the information. Yeah, sure. The date of service is [PII] and the bill amount is 4600 sorry.
[CUSTOMER][NEUTRAL] Sorry for that. The bill amount is $17,504.18.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] And can you verify the
[CUSTOMER][NEUTRAL] Yeah, sure. The provider's office, the facility name is Valley Regional Medical Center.
[AGENT][NEUTRAL] Thank you. And are you calling about the original claim or the um resubmitted claim?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] the.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] I need a general status and for this we don't submit any we don't submit any claim for this.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, so the original claim was received on [PII].
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 355.
[CUSTOMER][NEUTRAL] Claim number is 3551852.
[AGENT][NEUTRAL] 1852.
[AGENT][NEUTRAL] And also on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] And also in [PII] the call was designed.
[AGENT][NEUTRAL] Requesting the explanation of benefits from primary insurance?
[CUSTOMER][NEUTRAL] Explanation of benefits from insurance.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you need the second claim?
[CUSTOMER][NEUTRAL] Did you need the second claim?
[CUSTOMER][NEUTRAL] Uh, and this claim has been denied.
[CUSTOMER][NEUTRAL] Uh, denied for primary be apart from this, is there any other denial on this claim?
[AGENT][NEUTRAL] There's no other denial on this claim, but you resubmitted it with the with the providers um explanation of benefits, I'm sorry, insurance explanation benefits.
[CUSTOMER][NEUTRAL] No other denial on this claim, but you all submitted it with the with the provider's um explanation of benefits.
[CUSTOMER][NEUTRAL] OK, mm, OK.
[AGENT][NEUTRAL] Are you needing the claim status for that one as well?
[CUSTOMER][NEUTRAL] Are you
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So we received the claim on [PII].
[CUSTOMER][NEUTRAL] So we received the
[CUSTOMER][NEUTRAL] 2025. Hm.
[AGENT][NEUTRAL] The claim number is 357.
[CUSTOMER][NEUTRAL] Claim number is 357.
[AGENT][NEUTRAL] 8036.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 8036.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim.
[CUSTOMER][NEUTRAL] And on [PII] we paid out on the plane.
[AGENT][NEUTRAL] $2,422.05.
[CUSTOMER][NEUTRAL] 2,422,000.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Did you need any of the check information?
[CUSTOMER][NEUTRAL] OK, and yes, I need uh
[CUSTOMER][NEUTRAL] Payment information. Could you please tell me that?
[AGENT][NEUTRAL] Yes, hold on one moment.
[CUSTOMER][NEUTRAL] Yes, hold on one moment.
[AGENT][NEUTRAL] The check number is 2033812.
[CUSTOMER][NEUTRAL] Fax number is [PII].
[AGENT][NEUTRAL] It was a single check.
[CUSTOMER][NEUTRAL] They check
[AGENT][NEUTRAL] In the amount of $2,422.
[CUSTOMER][NEUTRAL] And the amount of $2,422.
[AGENT][NEUTRAL] And 5 cents.
[CUSTOMER][NEUTRAL] And 5 cents.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was issued on [PII].
[CUSTOMER][NEUTRAL] And uh yes, go ahead.
[AGENT][NEUTRAL] It was issued on [PII].
[CUSTOMER][NEUTRAL] It was issued on [PII].
[AGENT][NEUTRAL] And it cleared on [PII]?
[CUSTOMER][NEUTRAL] And it cleared on [PII]?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It was mailed to [PII].
[CUSTOMER][NEUTRAL] It was mailed to [PII].
[AGENT][NEUTRAL] 5
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Thank you. Thank you for your time and assistance. Could you please also provide me the call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] This is
[CUSTOMER][POSITIVE] OK, thank you. Thank you for your time and assistance. Have a great day.
[AGENT][POSITIVE] You're welcome, sir. Was there anything else I can help with?
[CUSTOMER][NEUTRAL] You're welcome, sir. Was there any
[CUSTOMER][NEUTRAL] That's it for today.
[AGENT][POSITIVE] Thanks for calling APL have a good day.
[CUSTOMER][POSITIVE] Thanks for calling ATI have a good day.