AccountId: 011433970860
ContactId: be817c26-6eed-4e6e-a20b-d91e314a9aa8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 600000 ms
Total Talk Time (AGENT): 149675 ms
Total Talk Time (CUSTOMER): 136043 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/be817c26-6eed-4e6e-a20b-d91e314a9aa8_20250611T17:53_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], this is uh [PII] and [PII]. Last initial, the first name is [PII] calling from provider's office. I want to know about the claim status. Can you assist me with that?
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with the claim status and [PII], how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Only one.
[AGENT][NEUTRAL] Alright and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII], and it's a direct line.
[AGENT][NEUTRAL] Thank you. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, sure. And that is 02494804, M as in Mi, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] That is [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 the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] The date of service is [PII] and the bill amount is $1,403.84.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold while I take a look for the claim?
[CUSTOMER][POSITIVE] OK, sure. Take your time.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for that wait. So is there any other total bill that it can be other than the $1,403.84?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Other claim you're asking?
[AGENT][NEUTRAL] Is there another total bill that it can be and also what's the name of the provider?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. The provider name is [PII].
[AGENT][NEUTRAL] I'm sorry, the facility name?
[CUSTOMER][NEUTRAL] Infectious disease physicians.
[AGENT][NEUTRAL] OK, because we have a claim on file for that date of service and it is from infectious disease physicians, but it's a different total bill.
[CUSTOMER][NEUTRAL] OK. So the claim is not on file for this.
[CUSTOMER][NEUTRAL] OK. So what is the total?
[AGENT][NEUTRAL] It's about $3 off. What's your tax ID number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, sure. And uh that is [PII].
[AGENT][NEUTRAL] OK, that's also the tax ID. Do you want me to give you this claim status? It's for $1400.
[CUSTOMER][NEUTRAL] 1400. But uh I have the bill amount is $1,403.84.
[AGENT][NEUTRAL] OK, well, this is that that balance only then no, we don't have a claim on file for you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Just, just a moment. Just, uh, give me a moment. I'm looking for that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, give me the claim status for that.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Give me the claim status for the 1400 bales a month.
[AGENT][NEUTRAL] OK, sure. I can give you the claim status. Hold on one moment.
[AGENT][NEUTRAL] So you received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 358.
[AGENT][NEUTRAL] 5930.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] And on [PII], we paid out on the claim?
[AGENT][NEUTRAL] A total of $515.27.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and that was applied to code A4222.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] The other code on file A 4305 was denied.
[AGENT][NEGATIVE] Um, because it doesn't meet the definition of durable medical equipment.
[CUSTOMER][NEUTRAL] Have you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 0.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So what need exactly for this?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][POSITIVE] Exactly what they need for this.
[AGENT][NEUTRAL] So it looks like this equipment is disposable.
[AGENT][NEUTRAL] And in order for it to qualify as a durable medical equipment, it needs to be non-disposable.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. So, we will submit the medical records for this. And what is the mailing address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK. What time defining limit?
[AGENT][NEUTRAL] Um, there's no timely filing limit as long as the policy was active on the data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I got that. And uh what is the call reference number for this?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date and again my name is [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] OK. Sure. Thank you so much, [PII], and have a good day and be safe.
[AGENT][POSITIVE] Thank you also. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, no. I'm done with that. Thank you so much. Once again.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.