AccountId: 011433970860
ContactId: bf9bb50c-1e37-45cc-915c-a50cbc3c79bd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 222479 ms
Total Talk Time (AGENT): 101894 ms
Total Talk Time (CUSTOMER): 58522 ms
Interruptions: 0
Overall Sentiment: AGENT=2.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/bf9bb50c-1e37-45cc-915c-a50cbc3c79bd_20250114T18:35_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi [PII], I need to ask a question about a claim please.
[AGENT][POSITIVE] Yeah, I'd love to help you with the claim today. Do you mind if I get your name and a good callback number?
[CUSTOMER][NEUTRAL] My name is [PII] and it's [PII] and that is my direct number.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] So sorry, one second, Ms. [PII], what's that member's policy number today?
[CUSTOMER][NEUTRAL] It's 02158964.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Perfect, give me a moment to get that pulled up for you.
[AGENT][NEUTRAL] And would you be able to verify for me, pretty please your your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Perfect, I do see that here and then do you have a particular claim number you're wanting to look at today?
[CUSTOMER][NEUTRAL] Um, I don't know if, let me see, I don't think we have a claim number, but the date of service is 2-17-24.
[AGENT][NEUTRAL] 21724. Perfect. And what was the billed amount on that claim, my friend?
[CUSTOMER][NEUTRAL] $313 even.
[AGENT][NEUTRAL] OK 1 2nd.
[AGENT][NEUTRAL] Would you be able to verify for me please the name of the provider on this claim?
[CUSTOMER][NEGATIVE] Um, and Mad Health.
[AGENT][NEUTRAL] Wonderful, thank you, and I do see that your claim is right here. I have it that we received [PII]. It looks like we processed the [PII] and your claim number is 3446216, and it looks like for this claim it says um it was denied, but it says please provide a copy of your explanation of benefits from your primary insurance carrier.
[AGENT][NEUTRAL] It looks like that EOB will be able to reevaluate the claim.
[CUSTOMER][NEUTRAL] OK, um, and that information was faxed, um.
[CUSTOMER][NEUTRAL] Oh, let's see it was faxed on.
[CUSTOMER][NEUTRAL] 45414 to fax number [PII].
[AGENT][NEUTRAL] Yeah, that is our fax number. I'm really sorry, I'm not showing that we've received anything.
[AGENT][NEUTRAL] On that date, um, we don't have a time limit though so if you're willing to resend that, um, we'll still we'll still be able to reconsider.
[CUSTOMER][NEUTRAL] Sure, yeah, OK, I will get that refaxed.
[AGENT][POSITIVE] Perfect um and then is there anything else I can help you with today, my friend?
[CUSTOMER][NEUTRAL] That'll be it.
[AGENT][POSITIVE] Perfect thank you so much and um I cannot talk thank you Miss [PII] for calling APL and if there's anything you do need please reach out to us we'll be happy to help you.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] My pleasure thank you bye bye.
[CUSTOMER][POSITIVE] Thanks. Bye-bye.