AccountId: 011433970860
ContactId: e13edc63-1225-4762-8954-c155b1b93dda
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 303339 ms
Total Talk Time (AGENT): 112779 ms
Total Talk Time (CUSTOMER): 105777 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/e13edc63-1225-4762-8954-c155b1b93dda_20250205T18:32_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 you from provider's office to check on a claim status. Can you please help me with that?
[AGENT][NEUTRAL] OK, so you do have one claim to check status on, is that correct?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 02335900 Mike L Lima 8. Can you please uh spell out your name?
[AGENT][POSITIVE] Thank you
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you for spelling out your name.
[AGENT][NEUTRAL] And any
[AGENT][NEUTRAL] You're welcome, and any information that I do provide for you today, [PII] 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] Yeah, the member first name is [PII] and the last name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][POSITIVE] You're welcome. OK, sure.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the data service and total bill amount please?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII] and the bill charges are
[CUSTOMER][NEUTRAL] $50,833 even.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] So I do show that this claim was received. One moment and I'll provide you that information. This claim was received on [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] So, sorry, uh, what was the date, process date?
[AGENT][NEUTRAL] The claim number
[AGENT][NEUTRAL] 1112.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you for providing me the information and uh what was the denial reason?
[AGENT][NEUTRAL] The claim number, do you want the claim number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] 352.
[AGENT][NEUTRAL] 8670.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the denial remark on this claim states please provide copies of your explanation of benefits from your primary insurance carrier.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Thank you for providing me the details. And can you please uh tell me how the primary uh we can be sent through? Is it through fax or mailing address? May I know that?
[AGENT][NEUTRAL] Either you may do either.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Can you please forward me the fax number then?
[CUSTOMER][NEUTRAL] A
[AGENT][NEUTRAL] The fax number is [PII] attention claims.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And if you need a copy of our
[CUSTOMER][POSITIVE] OK. Thank you for providing me the information.
[AGENT][NEUTRAL] Yes [PII], and if we need a copy of our explanation of benefits, you may go to our portal and print that yourself and our website for the portal is [PII]
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK. Thank you for providing me the information. And uh one moment, please.
[AGENT][POSITIVE] You're very welcome.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Do we need to send along with the UB04 form?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] No, so we just need the primary insurance company's explanation of benefits for this data service and build them out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, thank you for providing me the details and can you please also provide me the call reference number for this?
[AGENT][NEUTRAL] My name that I gave you along with today's date.
[CUSTOMER][POSITIVE] OK. Thank you for providing me the all the necessary details and information. It's been a pleasure talking with you. Have a nice day. Bye-bye. Take care.
[AGENT][NEUTRAL] Oh are you?
[AGENT][POSITIVE] Yes, you too, [PII] and thank you again for calling APL. I hope you have a nice rest of your day as well.