AccountId: 011433970860
ContactId: b89d9416-ac2f-49e2-bf08-11da7fc9a3b1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 250270 ms
Total Talk Time (AGENT): 90256 ms
Total Talk Time (CUSTOMER): 77671 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/b89d9416-ac2f-49e2-bf08-11da7fc9a3b1_20250507T18:28_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, this is [PII] calling you from AFC Urgent Care. This is regarding claim status and uh for
[CUSTOMER][NEUTRAL] Actually, claim in clarification for training and quality purpose, this call will be recorded and monitored.
[AGENT][NEUTRAL] OK, [PII], you're needing clarification on a denied claim, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with [PII]. What is your callback number, please?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] 02446516
[AGENT][POSITIVE] Thank you one moment while I get all of the information pulled up.
[AGENT][NEUTRAL] And [PII], any information that is provided today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, patient name is [PII] with the date of birth [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And again, any information provided will be a verification of benefits and not a guarantee of payment. What is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] [PII] with the bill amount $953.50.
[AGENT][NEUTRAL] Thank you and the claim number?
[CUSTOMER][NEUTRAL] Uh, claim number we have is
[CUSTOMER][NEUTRAL] 358-0081
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK. And how can I help you with that claim today?
[CUSTOMER][NEUTRAL] Yes. Actually, this claim got denied, am I right?
[AGENT][NEUTRAL] That is correct. It was denied because we need the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Thank you. Can I get the primary insurance name?
[AGENT][NEUTRAL] For her employer, we show that to be Blue Cross and Blue Shield of South Carolina.
[CUSTOMER][POSITIVE] Um, Blue Shield of South Carolina. Thank you so much. And uh is there any policy ID effective on term date?
[AGENT][NEUTRAL] For her primary insurance?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, you would have to contact Blue Cross.
[CUSTOMER][POSITIVE] Sure. Thank you so much. And how could you spell your name, ma'am, for documentation?
[AGENT][NEUTRAL] [PII] And if you need a copy of this explanation of benefits with that explanation on it, you can print that from our portal, Jack, and our portal website is located at [PII].
[CUSTOMER][NEUTRAL] Do
[CUSTOMER][NEUTRAL] Thank you. And uh also for this uh claim, we just need to know the uh covering sequence, the pair covering sequence.
[AGENT][NEUTRAL] Again, we are a supplemental policy only. We are not a major medical insurance company.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] And this the call reference number?
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][POSITIVE] Thank you so much. Have a great day.
[AGENT][POSITIVE] OK [PII], well if that's all I can help you with, thank you again for calling APL and I hope you have a nice day also.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, bye-bye.