AccountId: 011433970860
ContactId: c105cde7-ca3b-4fac-a896-1fc718535a35
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 327850 ms
Total Talk Time (AGENT): 155597 ms
Total Talk Time (CUSTOMER): 95010 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/c105cde7-ca3b-4fac-a896-1fc718535a35_20241230T21:01_UTC.wav
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[AGENT][NEUTRAL] Good afternoon, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] My name is [PII] calling from provider office. Need to check claim.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][POSITIVE] Yes, yes, yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Say that again.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] Member policy number 01663752ML7.
[AGENT][NEUTRAL] Did you say 01663752?
[CUSTOMER][NEUTRAL] Yes, M for Mike, L for Lima, 7.
[AGENT][NEUTRAL] Thank you. One moment. And any information [PII] that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you. What is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] of service, [PII] with bill amount.
[AGENT][NEUTRAL] Did you say [PII]?
[CUSTOMER][NEUTRAL] Yes, yes. [PII], we build on $11,281 even.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK, now there's no claim on file on this policy with that number. This policy was not active for that data service. This policy term 121-2020. Let me see if there's another policy on file. There is you have an old policy number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, the policy.
[CUSTOMER][NEUTRAL] Uh, I have one more. It's 02.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 02037372
[AGENT][NEUTRAL] That is the correct policy number for the data service that you would be inquiring on. This policy was active from 12-1-2020 to 11-12024. And just one moment for me to check to see if the claim was received on this policy.
[AGENT][NEUTRAL] OK, so this claim has been received. The received date on this claim was 10-9-2024, processed and denied on 10-17-2024.
[AGENT][NEUTRAL] The claim number is 351.
[AGENT][NEUTRAL] 8455.
[AGENT][NEUTRAL] The reason for the denial on this claim is it states to please provide copies of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK. Uh, may I know the fax number?
[AGENT][NEUTRAL] [PII]. Attention claims.
[CUSTOMER][NEUTRAL] Fax number 187.
[CUSTOMER][NEUTRAL] 7365 after that?
[AGENT][NEUTRAL] 7
[AGENT][NEUTRAL] Uh-huh. 942 [PII].
[AGENT][NEUTRAL] And if you need a copy of that explanation of benefits, 23.
[CUSTOMER][NEUTRAL] 94
[CUSTOMER][NEUTRAL] 943
[AGENT][NEUTRAL] 942-3. Mhm. If you need a copy of the explanation of benefits, you can get that from our portal by going to [PII].
[CUSTOMER][NEUTRAL] 23.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, it shows not fax. Uh, please confirm that one more time. That fax number is correct. It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 79423, right?
[AGENT][NEGATIVE] No. No, sir. That is not correct.
[AGENT][NEUTRAL] The last four numbers of the fax is 9423.
[CUSTOMER][NEUTRAL] 942 3.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] That's I brought it. OK. Just [PII] [PII].
[CUSTOMER][NEUTRAL] It's 877-365.
[AGENT][NEUTRAL] 9
[AGENT][NEUTRAL] 4
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 2
[CUSTOMER][NEUTRAL] 23
[AGENT][NEUTRAL] 3.
[CUSTOMER][POSITIVE] Uh, yeah, yeah, I got it. Yeah, I got it, got it.
[AGENT][NEUTRAL] And is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] Uh, no, thank you.
[AGENT][POSITIVE] OK, well then, thank you very much for calling APL [PII], and I hope that you have a nice evening and a happy [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, just a moment. You need the correct claim or, uh, along with private insurance you will be or only you will be?
[AGENT][NEUTRAL] We only need the primary insurance company's explanation of benefits.
[CUSTOMER][POSITIVE] OK. OK. Thank you.
[AGENT][POSITIVE] You're very welcome. And again, thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Uh, you're welcome.
[CUSTOMER][POSITIVE] Thank you.