AccountId: 011433970860
ContactId: ab478f64-9af3-4e41-ba11-87a4f9e66f91
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 304420 ms
Total Talk Time (AGENT): 66297 ms
Total Talk Time (CUSTOMER): 89143 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/ab478f64-9af3-4e41-ba11-87a4f9e66f91_20250606T14:02_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling from provider's office. I'm looking for the claim status who can with that.
[AGENT][NEUTRAL] Yes, I can help with claim status [PII]. Do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][POSITIVE] OK, thank you. And give me one moment.
[AGENT][NEUTRAL] And do you have the policy number for the patient?
[CUSTOMER][NEUTRAL] Yeah, it is 021.
[CUSTOMER][NEUTRAL] 73249.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII] with the date of birth, [PII].
[AGENT][NEUTRAL] OK, and the date of service and bill charges?
[CUSTOMER][NEUTRAL] So the date of service is [PII] with the billed amount $1,178.
[AGENT][NEUTRAL] No, it's 314-2025.
[CUSTOMER][NEUTRAL] It's [PII]. It's 4:14.
[AGENT][NEUTRAL] And what were the bill charges again?
[CUSTOMER][NEUTRAL] 1178.
[AGENT][NEUTRAL] Uh, was this for a facility claim or a physician claim?
[CUSTOMER][NEUTRAL] It's pole.
[CUSTOMER][NEUTRAL] I can provide you the claim ID.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, what's that?
[CUSTOMER][NEUTRAL] 3603189
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and you're needing the claim status?
[CUSTOMER][NEUTRAL] Actually, I can check here the claim got denied as CU 43 and they did not provide us the exact denial on the claim. So can you just go ahead and let me know what is the exact denial of the claim?
[AGENT][NEUTRAL] Uh, let me see.
[AGENT][NEUTRAL] Um, we're just waiting on eligibility verification from the employer, so from the group.
[AGENT][NEUTRAL] So once we receive that, we'll be able to send the claim back through for processing.
[CUSTOMER][NEUTRAL] Can you repeat that, please?
[AGENT][NEUTRAL] Um, we're waiting on benefit renewal information from the employer group.
[AGENT][NEUTRAL] So once that's received, we can process that.
[CUSTOMER][NEUTRAL] Benefits renewal.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] So you guys the benefit rate from the employer group.
[AGENT][NEUTRAL] Yes, we're waiting on the benefit renewal from the employer group.
[CUSTOMER][NEUTRAL] And can you just tell me any like turn around time, how much time it will take?
[AGENT][NEUTRAL] Uh, probably allow, uh, probably up to 7 to 10 more working days and it should be resolved.
[CUSTOMER][NEUTRAL] Oh, OK, give me one moment.
[AGENT][NEGATIVE] I'm sorry, you're breaking up.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So then once you guys will receive the benefit renewal plan and you guys will internally send it back for the process, is that correct?
[AGENT][NEUTRAL] Yes, once the renewal is complete, correct.
[CUSTOMER][NEUTRAL] OK, no problem. What will be the call reference on this claim?
[AGENT][NEUTRAL] It's my name is [PII], and today's date.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII] have uh have a great day.
[AGENT][POSITIVE] OK, thanks for calling APL you as well. Bye bye.