AccountId: 011433970860
ContactId: d2458a87-740d-44d7-a307-10f55c693a44
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 649500 ms
Total Talk Time (AGENT): 175758 ms
Total Talk Time (CUSTOMER): 122707 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/d2458a87-740d-44d7-a307-10f55c693a44_20250618T13:47_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, this is [PII] calling from provider office. I would like to know the claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, and did you say your name was [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Can you spell your first name for me, please?
[CUSTOMER][NEUTRAL] [PII] My last name, [PII] letter [PII].
[AGENT][NEUTRAL] Alright, and may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII]. It is a direct line. Policy number is
[AGENT][NEUTRAL] I'm sorry, can you speak slowly, please? [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the member's policy number?
[CUSTOMER][NEUTRAL] 024
[CUSTOMER][NEUTRAL] 933
[CUSTOMER][NEUTRAL] 93
[CUSTOMER][NEUTRAL] M as in Mike, L as in Lima, 7.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] First name is [PII].
[CUSTOMER][NEUTRAL] Last name is [PII]. Date of birth is [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 and the total bills for the claim?
[CUSTOMER][NEUTRAL] Date of service is [PII]. Total bill amount is $324 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] That is Holy Cross Hospital Medical.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 358.
[AGENT][NEUTRAL] 6144.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Um, there's a few reasons, office visits are not covered by this policy.
[AGENT][NEUTRAL] And then let me get the 2nd 1. Hold on one moment.
[AGENT][NEUTRAL] And the policy doesn't provide a benefit in which no charges were incurred.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, could you please fax that, uh, denied EOB?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] Yeah, my fax number is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And for the um attention, can you spell your first name again, please?
[CUSTOMER][NEUTRAL] Yes, [PII] Yes, [PII]
[AGENT][NEUTRAL] Thank you and [PII], um, is it alright if I place you on just a brief hold while I send the explanation of benefits over to you?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So I've sent the fax over to you, so you should be receiving that shortly. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Yeah, I have 2 more clients with the same patient.
[AGENT][NEUTRAL] OK, may I have the other dates of service and total bills?
[CUSTOMER][NEUTRAL] Yeah, just give me 1 2nd.
[CUSTOMER][NEUTRAL] Date of service is [PII]. Total bill amount is $661 even.
[AGENT][NEUTRAL] And the last date of service?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[AGENT][NEUTRAL] Right, you said you had 2 more, that's only 1. Are they both on the same day in different amounts?
[CUSTOMER][NEUTRAL] OK, OK. Uh, you are asking, uh, another one also, OK. That one date of service is [PII]. Total bill amount is $599 even.
[AGENT][NEUTRAL] And is that [PII] or [PII] for the second one?
[AGENT][NEGATIVE] I, I didn't, I, I didn't get the date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] $599. OK.
[AGENT][POSITIVE] Alright, thank you.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so I just found the first one I'm waiting for the 2nd 1 to come up now.
[AGENT][NEUTRAL] We need a copy of the explanation of benefits for these two as well?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, exactly.
[AGENT][NEUTRAL] OK. So for um [PII], in the amount of 661, we received that claim on [PII].
[AGENT][NEUTRAL] Actually, so we received both of the claims on [PII].
[AGENT][NEUTRAL] They were both processed on [PII].
[AGENT][NEGATIVE] They were both denied for the same reasons, office visits are not covered.
[AGENT][NEUTRAL] The claim number for the amount of 661 is 358-6133.
[AGENT][NEUTRAL] And for the 599 amount, that claim number is 358-6132.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. Could you please fax that to to EOB?
[AGENT][POSITIVE] Yes, I'll be sending them both to you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alrighty. Was there anything else I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] Uh, no, thank you so much. Could you spell out your name?
[AGENT][NEUTRAL] Sure, my name is [PII] First initial to my last name is [PII].
[CUSTOMER][NEUTRAL] May I know the call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date.
[CUSTOMER][POSITIVE] OK. Thank you so much for the client. Have a nice day. And how much time it will take to receive AOB?
[AGENT][POSITIVE] We usually say to get faxes at least an hour. If you haven't received it by end of day today, you can definitely give us a call and we'll be more than happy to resend it for you.
[CUSTOMER][POSITIVE] OK, yeah, thank you so much. Have a nice day. Bye.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help with?
[CUSTOMER][POSITIVE] No, thank you so much.
[AGENT][POSITIVE] Alright, you're welcome. Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.