AccountId: 011433970860
ContactId: d8efdf40-f1b3-4d6b-9f30-1691ca929084
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 322700 ms
Total Talk Time (AGENT): 129588 ms
Total Talk Time (CUSTOMER): 54320 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/d8efdf40-f1b3-4d6b-9f30-1691ca929084_20250326T17:40_UTC.wav
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[AGENT][POSITIVE] Good
[AGENT][NEUTRAL] Afternoon, thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is I'm calling from provider's office to check on a claim status.
[AGENT][NEUTRAL] OK [PII], you have one claim that you're needing to check claim status.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] The phone, is that correct?
[AGENT][POSITIVE] Yes, I can help you with that and then what is your call number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] 02141739
[CUSTOMER][NEUTRAL] M as in Mike.
[AGENT][POSITIVE] OK, thank you. Mhm.
[CUSTOMER][NEUTRAL] L as in Lima, 7.
[AGENT][NEUTRAL] OK, thank you very much one moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And Sa any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] The patient name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her?
[CUSTOMER][NEUTRAL] [PII] bill amount $8,853 even.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] OK, so this claim does shows received 3-12-2025 processed the same date.
[CUSTOMER][NEUTRAL] well
[AGENT][NEUTRAL] The claim number?
[AGENT][NEUTRAL] It's 357.
[AGENT][NEUTRAL] 4647.
[AGENT][NEUTRAL] And this claim was denied?
[AGENT][NEUTRAL] The reason for the denial, Sam states benefits are payable only.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] if your major medical insurance provides benefits.
[AGENT][NEUTRAL] If this claim is later paid by your major medical insurance, please send the explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] Showing.
[CUSTOMER][NEUTRAL] So I need the primary will be?
[AGENT][NEUTRAL] Showing benefits were paid. Again, this plan only pays if the major medical insurance provider provides benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If the claim is paid by the major medical insurance?
[CUSTOMER][NEUTRAL] So this is um
[AGENT][NEUTRAL] And yes, place in the explanation of benefits showing benefits were paid.
[CUSTOMER][NEUTRAL] Coinsurance
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I have the fax number?
[AGENT][NEUTRAL] It would be [PII] attention claims.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits, [PII], you can print that from our portal now that you have the claim number by going to secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][POSITIVE] You're very welcome. And is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, thank you. Can I have the call reference?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am, you would use my name along with today's date.
[CUSTOMER][POSITIVE] Thank you so much. Have a good day.
[AGENT][POSITIVE] Well, you're welcome. Yes, ma'am. So thank you again for calling APO, Sam. I hope you have a nice.