AccountId: 011433970860
ContactId: c27dd692-13ee-4e39-9eec-261b115658a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 166279 ms
Total Talk Time (AGENT): 78527 ms
Total Talk Time (CUSTOMER): 48579 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/c27dd692-13ee-4e39-9eec-261b115658a9_20250206T22:08_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][NEGATIVE] Con.
[CUSTOMER][NEUTRAL] [PII] hi I need claim status please.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that. And for my notes, can you spell your first name for me, please, and the policy number?
[CUSTOMER][NEUTRAL] [PII] 02493162.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [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 for the claim you want me to check on?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] 14,571 even.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Bayside Ambulatory Center.
[AGENT][NEUTRAL] Here we go. All right, so I'm showing the claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3505427.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because the outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] Can you pass me a copy of that EOB?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And should I put attention [PII]?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] All right, so I'm sending that over to you now. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] A reference number for the call if you do give one out.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date and again that's [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you, [PII]. Have a good day. Good afternoon.
[AGENT][POSITIVE] You're welcome. You also, and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.