AccountId: 011433970860
ContactId: a737ed8f-974c-4d0b-8f3a-36550a847dbd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 377859 ms
Total Talk Time (AGENT): 128862 ms
Total Talk Time (CUSTOMER): 84925 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/a737ed8f-974c-4d0b-8f3a-36550a847dbd_20250521T13:03_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] Hello. Good morning, [PII]. My name is [PII], and I'm calling on behalf of a facility, calling to see if you have an appeal on file. I had it um mailed in a couple of times, um, and you guys haven't received it, so I had it mailed again and I just wanna see if you received it this time.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, I can definitely check and see if the claim is or the appeal is here. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh-huh. It is [PII], and that's my direct line.
[CUSTOMER][NEUTRAL] And the policy number is 2586493.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Um, Eadiverge, um, [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 bills?
[CUSTOMER][NEUTRAL] Uh-huh, it is [PII].
[AGENT][NEUTRAL] And the total bill?
[CUSTOMER][NEUTRAL] $84,0007.48.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, and do you mind if I place you on just a brief hold while I search for the claim and the appeal?
[CUSTOMER][POSITIVE] OK, yes, thank.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Wait a minute, I don't see anything here. OK, wait.
[AGENT][NEUTRAL] [PII], so it will be here.
[AGENT][NEUTRAL] Right, because, well, let's look at both, I guess, cause I don't see anything on this one.
[AGENT][NEUTRAL] OK. 231-1714.
[AGENT][NEUTRAL] Let's see what we can.
[AGENT][NEUTRAL] Come up with
[AGENT][NEUTRAL] 18.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] Wait.
[AGENT][NEUTRAL] Wait a minute, this is all one claim 3,561,840.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] What are they appealing? The max was paid to them.
[AGENT][NEUTRAL] Oh [PII], and this is Hustle indemnity, so I will have to add it all up.
[AGENT][NEUTRAL] Well, there goes the
[AGENT][NEUTRAL] All right, so that's the hospital charge.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] They're not another line up.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So no, I'm not seeing an appeal um that has been received. What mailing address are you sending it to?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] I don't know what's going on.
[AGENT][NEUTRAL] OK, that's the correct mailing address.
[AGENT][NEUTRAL] Um, they have a payer ID.
[CUSTOMER][NEUTRAL] Mhm. And I sent it twice.
[AGENT][NEUTRAL] They have a payer ID as well if you want to try to send.
[AGENT][NEUTRAL] Electronically, um,
[AGENT][NEUTRAL] That's the only option for IMA. They don't have a fax number or anything to give you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Um, what's the payer ID?
[AGENT][NEUTRAL] So it's 64.
[AGENT][NEUTRAL] 556.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] And they don't have like an email that's the only option just to mail it.
[AGENT][NEUTRAL] Or the electronic.
[CUSTOMER][NEUTRAL] OK. Uh, I'll give it a try.
[AGENT][POSITIVE] All right, well, I'll go ahead and note the policy for you. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] No, that'd be all, just a reference number.
[AGENT][NEUTRAL] 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][POSITIVE] All right, thank you so much. I appreciate your help.
[AGENT][POSITIVE] You're welcome, [PII] and thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.