AccountId: 011433970860
ContactId: ca7cf7ce-7ae4-4e2e-8649-c43f544ac943
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 540119 ms
Total Talk Time (AGENT): 189130 ms
Total Talk Time (CUSTOMER): 159297 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/ca7cf7ce-7ae4-4e2e-8649-c43f544ac943_20250303T14:07_UTC.wav
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[AGENT][POSITIVE] Good. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm [PII] and I'm calling behalf of provider's office looking for claim status.
[AGENT][NEUTRAL] I'm sorry, I did not understand your name.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII], and you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that and what is your callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] I'm sorry, did you say [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so let's do this again. [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What is [PII]?
[AGENT][NEUTRAL] Repeat your phone number for me, [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. The [PII].
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] I do have a
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I do have two claims
[AGENT][NEUTRAL] OK, for different patients.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so first off, [PII], you will use my name that I gave you along with today's date as your call reference number for each one. Also, any information that I provide for you will be a verification of benefits and not a guarantee of payment. And lastly, if we do have the claims on file and you need a copy of the explanation of benefits, you can print that from our portal by going to secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. And what is the first patient's policy number?
[CUSTOMER][NEUTRAL] Sure. Is it uh 216-656-7?
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And and what is your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] [PII] for it and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And the date of service and total bill amount for her?
[CUSTOMER][NEUTRAL] [PII] with the bill amount of $164 even.
[AGENT][NEUTRAL] Did you say the year is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] So I like this.
[AGENT][NEUTRAL] OK, so this claim was received and processed. It was received on [PII].
[AGENT][NEUTRAL] Processed on [PII].
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] The claim number is 3385829.
[AGENT][NEUTRAL] This claim was denied, [PII].
[AGENT][NEUTRAL] And the reason for the denial states to please provide copies of the primary, excuse me, please provide copies of your explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] May I know who's the primary insurance?
[AGENT][NEUTRAL] Now for her employer, we show it to now be Allstate benefits. I do not know who that would have, it would have been in [PII], you would have to contact the patient.
[CUSTOMER][NEUTRAL] So may I know when was the
[CUSTOMER][NEUTRAL] Last time you was updated.
[AGENT][NEUTRAL] We are not a major medical insurance company. This is a supplemental plan only.
[CUSTOMER][NEUTRAL] OK. Thank you. And tell me what the next claim please.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Like uh.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm gonna, um, just one moment. Sorry.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Is it 021-66571?
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] You're very.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] In the end of the day.
[CUSTOMER][NEUTRAL] This.
[AGENT][NEUTRAL] OK. And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is [PII] and the date of birth is, sorry, not reserve and the date of birth is [PII].
[AGENT][NEUTRAL] I'm sorry, what was the date of birth one more time, please?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And the data service and total bill amount.
[CUSTOMER][NEUTRAL] [PII] with the bill of $68 even.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh hi
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] 200.
[AGENT][NEUTRAL] OK, this claim was received on [PII].
[AGENT][NEUTRAL] Processed and denied on [PII].
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Claim number is 3391606.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] And this claim was also denied because we need the primary insurance company's explanation of benefits.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII], for your wonderful assistance. Have a good day.
[AGENT][POSITIVE] Yeah, you're very welcome. Is there anything else that I can help you with today, [PII]?
[CUSTOMER][POSITIVE] No, thank you so much. And the reference number will be your name in the date.
[AGENT][POSITIVE] OK, well, you're very welcome.
[AGENT][POSITIVE] That is correct. Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] OK, well, you're very welcome and again, thank you for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.