AccountId: 011433970860
ContactId: bde6eb7a-9711-43b8-b408-a0c5fbf3c743
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 172470 ms
Total Talk Time (AGENT): 83967 ms
Total Talk Time (CUSTOMER): 46470 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/bde6eb7a-9711-43b8-b408-a0c5fbf3c743_20241230T20:39_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, yes, um, I just need to see if a claim has come through.
[AGENT][NEUTRAL] OK, well, I can check the claim for you. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] Is 02261126.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Do you want the patient or who the insurance is under?
[AGENT][NEUTRAL] Oh, the whoever the claim is for.
[CUSTOMER][NEUTRAL] Oh, [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 may I have the date of service for um her claim?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, Dr. [PII]
[AGENT][NEUTRAL] It was [PII].
[AGENT][NEUTRAL] OK, it looks like we do have a claim. What's the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, this is it. So yes, we received the claim.
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] That claim number is 353.
[AGENT][NEUTRAL] 5717.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the policy does not provide benefits for any procedure or service um not listed in the schedule.
[AGENT][NEUTRAL] Um, I've covered dental services.
[CUSTOMER][NEUTRAL] OK, so can I get that denial faxed to me so I can send it to a secondary insurance?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do I need to put attention, [PII]?
[CUSTOMER][NEUTRAL] Nope, I'll grab it right when it comes through here.
[AGENT][NEUTRAL] OK, and it's [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, so I'm faxing this over to you now. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, that's good thank you.
[AGENT][POSITIVE] Well, you're very welcome and thanks for calling APL. I hope you have a happy new year.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][NEUTRAL] Bye bye.