AccountId: 011433970860
ContactId: d1f37035-3829-4b93-bbcc-406077f52394
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 450380 ms
Total Talk Time (AGENT): 163915 ms
Total Talk Time (CUSTOMER): 66258 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/d1f37035-3829-4b93-bbcc-406077f52394_20250207T18:54_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, this is [PII] calling from provider's office to know the claim status.
[AGENT][NEUTRAL] I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Yeah, it's
[CUSTOMER][NEUTRAL] So, [PII]
[AGENT][NEUTRAL] Spell your name for me please.
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII].
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And what is your callback number, please?
[CUSTOMER][NEUTRAL] Yeah, my callback number is [PII].
[AGENT][NEUTRAL] Thank you and you are needing claim statususha, is that correct?
[CUSTOMER][NEUTRAL] Yes, claim status.
[AGENT][NEUTRAL] Yes, I can help you with that. And how many claims initiative you have to check status on?
[CUSTOMER][NEUTRAL] Yeah, only one claim.
[AGENT][NEUTRAL] OK, and what is that member's policy number, please?
[CUSTOMER][NEUTRAL] Yeah, the member's policy ID is 02539166.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And any information in issue that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for him?
[CUSTOMER][NEUTRAL] Yeah, the data service is [PII] and total charge is $926 even.
[AGENT][NEUTRAL] OK, and again on the data service that's 920, is that correct?
[CUSTOMER][NEUTRAL] No, it's [PII].
[AGENT][NEUTRAL] 925 of [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] And the facility name for this claim, the provider group name?
[CUSTOMER][NEUTRAL] Yeah, it's Mount Carmel Medical Group.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] It's still loading a piece of information for me, so thank you for your patience, [PII].
[CUSTOMER][POSITIVE] Yeah, no problem.
[AGENT][NEUTRAL] OK, so this claim was received.
[AGENT][NEUTRAL] If they received it was 10-9-2024.
[AGENT][NEUTRAL] The process date was [PII].
[AGENT][NEUTRAL] The claim number is 351.
[AGENT][NEUTRAL] 792 5.
[AGENT][NEUTRAL] And this claim was denied?
[AGENT][NEUTRAL] The denial remarks are this policy does not provide benefits for vaccines and immunizations or the administration of the injections.
[AGENT][NEUTRAL] And this policy does not provide a wellness expense benefit.
[CUSTOMER][NEUTRAL] Yeah, could you please fax the EU.
[AGENT][NEUTRAL] I can try and fax it to you, but I'm also going to give you a website for future reference initiatives so that you can print them yourself from our portal now that you have the claim number. Our portal website is [PII].
[AGENT][NEUTRAL] And again, you will be able to print them from the portal.
[AGENT][NEUTRAL] Just one moment.
[CUSTOMER][POSITIVE] Yeah, thank you so much.
[AGENT][NEUTRAL] You're welcome. So just a moment while it's pulling up the EOB for you.
[AGENT][NEUTRAL] Still loading.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] And does it need to be put to your attention or is that not necessary?
[CUSTOMER][NEUTRAL] Yeah, it's my attention [PII].
[AGENT][NEUTRAL] And what is the fax, good fax number for you please, [PII]?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, I'm gonna repeat that back to you. [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, so I have just faxed that to you. So provided you're able to receive it, you should be receiving that within just the next several minutes.
[CUSTOMER][POSITIVE] Yeah, thank you so much for that.
[AGENT][POSITIVE] You're very welcome. And again, is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] Yeah, can I get the call reference, please?
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][POSITIVE] Yeah, thank you so much. Thank you so much for assisting me.
[AGENT][POSITIVE] You're absolutely, you're very welcome and thank you again for calling APL. I hope you have a nice weekend.
[CUSTOMER][POSITIVE] You too. Take care. Bye-bye.
[AGENT][POSITIVE] Thank you. Yes, ma'am. Thank you. Bye-bye.