AccountId: 011433970860
ContactId: c1a78701-2327-4c19-b5d4-66efb2e1c537
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 510290 ms
Total Talk Time (AGENT): 179872 ms
Total Talk Time (CUSTOMER): 142138 ms
Interruptions: 2
Overall Sentiment: AGENT=1.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/c1a78701-2327-4c19-b5d4-66efb2e1c537_20250305T18:43_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] Hi, [PII]. This is [PII] calling from provider office checking on a claim status.
[AGENT][NEUTRAL] OK, [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that, [PII] and what is your callback number?
[CUSTOMER][NEUTRAL] My callback number is [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] The member policy number is 1524156 M as in Mary.
[CUSTOMER][NEUTRAL] I as in igloo, number 7.
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And any information [PII] that I provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the date of service please and total bill amount.
[CUSTOMER][NEUTRAL] The rate of service is [PII] with the total bill amount of $2780 even.
[AGENT][NEUTRAL] 2780. Is that correct?
[CUSTOMER][NEUTRAL] 2788.
[AGENT][NEUTRAL] 88. OK, thank you. One moment.
[AGENT][NEUTRAL] OK, just one moment please.
[AGENT][NEUTRAL] OK, so I do show that this claim was received. The received date on here is [PII].
[AGENT][NEUTRAL] It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3505543.
[AGENT][NEUTRAL] And the denial on this claim, the remarks state one moment.
[AGENT][NEUTRAL] It states we have received a primary explanation of benefits that was submitted with your claim. However, the explanation of benefits received does not list the amounts applied to the deductible, co-pay, or co-insurance. Please submit a more detailed explanation of benefits that shows these amounts for further consideration of your claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Because it is.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is the it's it's like.
[AGENT][NEUTRAL] So we need a detailed primary insurance explanation of benefits showing.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The amounts applied to the co-pays, deductibles, and co-insurance.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits with that information on there, you can print that from our portal, Leo, by going to [PII].
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got it, just give me a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Be more.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] On my.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] What I.
[AGENT][NEUTRAL] And actually, Leah, give me just a moment to look at one more thing. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like we did receive that information.
[CUSTOMER][NEUTRAL] It's not, but they need.
[AGENT][NEUTRAL] On [PII] and it was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Under claim number 354.
[CUSTOMER][NEUTRAL] Like.
[AGENT][NEUTRAL] 1218.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And give me one moment to get that information pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 43 Global 13.
[CUSTOMER][NEUTRAL] You.
[AGENT][NEUTRAL] OK, so there was a benefit paid on this claim in the amount of $441.32.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That was paid on single check 201.
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] 854 7.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. The allowed and the paid amount is same.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Which is $441.32 right?
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] What is the mailing address?
[CUSTOMER][NEUTRAL] The meeting, just give me a moment. The meeting address is.
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII].
[AGENT][POSITIVE] OK thank you yes sir that is where it was mailed to.
[CUSTOMER][NEUTRAL] Uh, [PII], uh, do you have the cast of this check at your end?
[AGENT][POSITIVE] It is still showing that this check is outstanding.
[CUSTOMER][NEUTRAL] OK. When was this check issued?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so it has not crossed the 90 days yet. So, OK, got it.
[AGENT][NEUTRAL] That is
[AGENT][NEUTRAL] Yes, sir. So is there anything else that I can help you with?
[CUSTOMER][NEUTRAL] Yeah, just the call reference number.
[AGENT][NEUTRAL] Sure, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] And last initial to your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you for that, [PII].
[CUSTOMER][POSITIVE] Thank you for your assistance. Hope you have a wonderful day ahead bye for now.
[AGENT][POSITIVE] Well, you're so, yes, sir, sir, OK, if that is all then that I can help you with today, [PII], thank you again for calling APL and I hope you have a nice day also.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][NEUTRAL] Uh, bye-bye.
[CUSTOMER][NEUTRAL] Taking a lot and.