AccountId: 011433970860
ContactId: e534d143-73d4-4b59-9f93-89b7da84db83
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 244740 ms
Total Talk Time (AGENT): 93247 ms
Total Talk Time (CUSTOMER): 59258 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/e534d143-73d4-4b59-9f93-89b7da84db83_20250310T19:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] and I'm calling from the provider's office to check on the claim status.
[AGENT][NEUTRAL] OK. A, you have one claim to check status on, is that correct?
[CUSTOMER][POSITIVE] That's right.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII] with [PII] [PII].
[AGENT][NEUTRAL] Thank you and [PII], what is the member's policy number?
[CUSTOMER][NEUTRAL] Uh, the member ID is 02547209.
[AGENT][POSITIVE] Thank you, one moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And your patient's name? Well, first off, [PII], any information that I provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and date of birth is [PII].
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her please [PII]?
[CUSTOMER][NEUTRAL] It's [PII] and the total bill amount is $841 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, [PII], this claim was received. The received date was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] It's processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3563594.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And again, what is the, yes, and again, what is the provider facility name?
[CUSTOMER][NEUTRAL] And may I know the denial reason?
[CUSTOMER][NEUTRAL] Uh, the facility's name is Mary Hitchcock Memorial Hospital.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the reason for the denial states policy provides no benefits.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] For the treatment of conditions other than a sickness or injury as defined by the policy.
[CUSTOMER][NEUTRAL] Alright, so this is basically nonprofit right?
[AGENT][NEUTRAL] And if you need a copy.
[AGENT][NEUTRAL] That is correct, under the patient's plan.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits, Ash, now that you have the claim number, you can print that from our portal by going to [PII].
[CUSTOMER][NEUTRAL] All right, and uh.
[CUSTOMER][NEUTRAL] Also, uh, I can have a call reference number for this call [PII].
[AGENT][NEUTRAL] Yes, you would use my name along with today's date.
[CUSTOMER][POSITIVE] Alright, [PII], and thank you so much for assisting with this claim.
[AGENT][POSITIVE] OK. Well, you're welcome. Can I help you with anything else?
[CUSTOMER][POSITIVE] Uh, I just had this claim with me, [PII], but thank you and have a great day. Bye.
[AGENT][POSITIVE] Oh, well you, well, you're welcome, [PII] and thank you again for calling APL. I hope you have a great day as well.
[CUSTOMER][NEUTRAL] Yeah bye.
[AGENT][NEUTRAL] Bye bye.