AccountId: 011433970860
ContactId: baa3ebff-bdec-4c08-a0c0-e3cc359ddc63
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 273890 ms
Total Talk Time (AGENT): 110688 ms
Total Talk Time (CUSTOMER): 101372 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/baa3ebff-bdec-4c08-a0c0-e3cc359ddc63_20250423T17:44_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Prisma Health. I'm needing to speak with someone on a claim denial.
[AGENT][NEUTRAL] OK, well, I'll be more than happy to help you with the claim [PII], and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Sure, my phone number is [PII].
[CUSTOMER][NEUTRAL] And patients benefit number is D as in dog 43730287.
[AGENT][NEUTRAL] OK, do you have a copy of the member's ID card available or the explanation of benefits?
[CUSTOMER][NEUTRAL] Sure I have the card.
[AGENT][NEUTRAL] OK, on the card, do you see anywhere that says in hospitals or outpatient policy cert number?
[CUSTOMER][NEUTRAL] Let me see.
[AGENT][NEUTRAL] It should start with a 01 or 02?
[CUSTOMER][NEUTRAL] Policy start number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, 024.
[CUSTOMER][NEUTRAL] 81,710.
[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] [PII], [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 either the claim number or the date of service for the claim you like me to look at with you?
[CUSTOMER][NEUTRAL] Sure, there's actually two claims I think um with the same denial. The first one claim number is 3558851.
[AGENT][NEUTRAL] OK, and the second one?
[CUSTOMER][NEUTRAL] The next one is.
[CUSTOMER][NEUTRAL] Claim number 3558977.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so yeah, they were both denied because the the policy provides no benefits for charges made by a doctor for inpatient visits, and then what questions did you have?
[CUSTOMER][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] I didn't have any questions. I just wanted to make sure that that was the reason our EOB literally just says that it's not covered under the plan, and I didn't know if that was because it was done in patient, so I did wanna verify.
[AGENT][NEUTRAL] Oh, did you need me to send you a copy of the explanation of benefits? Do you have a front and back or is it just one page?
[CUSTOMER][NEUTRAL] Let me see, it's through our, um, like a third party who does our EOBs and it's just very generic when it comes to our EMR um they probably have it right on their end, but like I said when we're just looking at it here, it doesn't, it doesn't say too much so but um yeah um actually do you guys have a website I could get it from that way?
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEGATIVE] It doesn't give you
[AGENT][NEUTRAL] Yes, um, you can sign up for our patient, well, our online portal, there's a provider section, um, and then you'll be able to search claim status, um, and you'll be able to access the explanation of benefits as well.
[AGENT][NEUTRAL] So the website is [PII].
[CUSTOMER][POSITIVE] OK, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII],
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then as soon as the page populates to the top right corner, you'll see where it says sign in and you'll go ahead and click there and um follow the prompts for a new user provider.
[CUSTOMER][POSITIVE] OK, great. I will look at it that way. Thank you so much for your help. Do you have a reference number for the call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date and the first initial to my last name is [PII], again, I'm [PII]
[CUSTOMER][POSITIVE] Perfect thank you so much [PII].
[AGENT][POSITIVE] You're very welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, ma'am, that was it.
[AGENT][POSITIVE] Alright, thanks for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][POSITIVE] Thank you bye bye.