AccountId: 011433970860
ContactId: b8b09e48-ee02-4e36-ad3b-1acb98fb9134
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 519847 ms
Total Talk Time (AGENT): 147048 ms
Total Talk Time (CUSTOMER): 155436 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/b8b09e48-ee02-4e36-ad3b-1acb98fb9134_20250402T19:57_UTC.wav
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[AGENT][POSITIVE] Good afternoon.
[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, very good afternoon. My name is [PII] calling from the product office checking on claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII], and may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Uh, it's gonna be the contact number, it's gonna be uh [PII]. And the policy number, it's gonna be.
[CUSTOMER][NEUTRAL] 01737544 ML 8. And how do you spell spell your name?
[AGENT][NEUTRAL] Um, [PII], first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Hello sir.
[CUSTOMER][NEUTRAL] Yes, I'm there.
[AGENT][NEUTRAL] Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, uh, member's first name is gonna be, uh, it's, I'll just spell it out, sir. [PII].
[CUSTOMER][NEUTRAL] And uh [PII], and the last name it's gonna be [PII] and the date of birth is on [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bill for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Uh yeah. Uh, the date of service is on [PII] for the total charges of $9,516 even.
[AGENT][NEUTRAL] Thank you. Hold on one moment. Again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment while I locate the claim for you, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 348.
[AGENT][NEUTRAL] 8979.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the inpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. So is it uh possible that you can uh fax it to us?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] It's gonna be [PII].
[AGENT][NEUTRAL] And does that need to be attention, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alright, so I'll go ahead and fax the explanation of benefits over to you now. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And can I get the call reference number? I do have one more invoice with me, uh, one more claim with me. Can you help me with that?
[AGENT][NEUTRAL] Yes, um, so there is no call reference number. You can use my name in today's date and then hold on one moment, let me, is it the same number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No, a different one.
[AGENT][NEUTRAL] OK, so there's more than one claim. OK, hold on one moment, let me um send this fax over to you and note this policy and then we can move on to the next one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes, I'm there.
[AGENT][POSITIVE] Thank you so much for holding. And may I have the next member's policy number?
[CUSTOMER][NEUTRAL] Sure, just a moment.
[CUSTOMER][NEUTRAL] Uh, it's gonna be 000947098.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, member's first name is gonna be [PII] and the last name will be, uh, I just spell it out, [PII], and the date of birth is on [PII].
[AGENT][NEUTRAL] OK, and that was um policy number 947-098?
[CUSTOMER][NEUTRAL] 947-098 yes.
[AGENT][NEUTRAL] OK, because that's bringing up a different member. Um, do you have the member's full social?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, can you spell the member's first and last name again? I can search with the name.
[CUSTOMER][NEUTRAL] Sure, member's first name, [PII].
[CUSTOMER][NEUTRAL] And the last name, I just spell it out. It's uh [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so with the first name is [PII] the policyholder?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, the reason I'm asking is because there's no policy here with that first name and last name, um, and if you don't have the full social, there's nothing else that I can search with. Do you have a claim number?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, so yeah, we're gonna need more information because the policy number didn't pull up this number and then with the first and last name, there's no policy and we don't have the social to search with.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, got it. So thank you, [PII], for the information provided. I hope you have a good day. Stay safe. Thank you for now.
[AGENT][POSITIVE] Thank you, [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] All right, well, thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.