AccountId: 011433970860
ContactId: bc23b942-e455-45f8-9f5b-d91f6ad1a725
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 266589 ms
Total Talk Time (AGENT): 112782 ms
Total Talk Time (CUSTOMER): 58655 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/bc23b942-e455-45f8-9f5b-d91f6ad1a725_20250506T13:17_UTC.wav
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[CUSTOMER][NEUTRAL] It
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] And uh I need to um check the status of claim.
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with the claim status. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes [PII] [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] It is where did it go? 02587781.
[AGENT][POSITIVE] Thank you for that.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment, and I'm sorry, I confused myself. Did you say claim status or eligibility?
[CUSTOMER][NEUTRAL] For claim status.
[AGENT][NEUTRAL] OK, that's what I put down. OK. And I am showing the policy is active, it's been effective since [PII]. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] It is [PII] [PII]. Charges are for $32,395.29.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] OK, and I just located the claim. Can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Mhm. It's Emery Decatur Hospital. Um, it may be also listed as DeKalb Medical.
[CUSTOMER][NEUTRAL] Center.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] 3229 here we go.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 3596561.
[AGENT][NEUTRAL] And on [PII], the claim, uh, we paid out on the claim, a total of $1800.
[AGENT][NEUTRAL] Did you need that check information?
[CUSTOMER][NEUTRAL] Yes, let me get that.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so I'm showing a single check, check number 2,042,450.
[AGENT][NEUTRAL] It was issued on [PII].
[AGENT][NEUTRAL] Of [PII].
[AGENT][NEUTRAL] And it was mailed to [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Was there any um denied charges on there?
[CUSTOMER][NEUTRAL] Or anything.
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEGATIVE] Um, the ER charge for $2500 was denied because the maximum for the data service was met.
[CUSTOMER][NEUTRAL] OK. Any other charges? Cause that's uh
[AGENT][NEUTRAL] Mm, everything else was paid on.
[CUSTOMER][NEUTRAL] Everything else was paid on, OK.
[CUSTOMER][NEUTRAL] Alright, you have a reference number for the call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name on today's date. Um and again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, all right, thank you so much.
[AGENT][POSITIVE] You're welcome [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] That was it.
[AGENT][POSITIVE] Alright, well thank you so much for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.