AccountId: 011433970860
ContactId: e862848d-73a9-42e5-8104-b890cf6aed61
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 289589 ms
Total Talk Time (AGENT): 114046 ms
Total Talk Time (CUSTOMER): 83011 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/e862848d-73a9-42e5-8104-b890cf6aed61_20250103T16:57_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]. I'm calling from Riverview Hospital to see if a claim has been received.
[AGENT][POSITIVE] Great, I'm happy to check on the claim for you today. Do you have the patient's policy number?
[CUSTOMER][NEUTRAL] I have their member ID. It's uh 02518263.
[AGENT][NEUTRAL] Alright, that should work. Let me pull that up here one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then what is the patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] All right, thank you so much for that and then what is the date of service?
[CUSTOMER][NEUTRAL] Data service is [PII].
[AGENT][NEUTRAL] Alright, and the build out?
[CUSTOMER][NEUTRAL] $3,553
[AGENT][NEUTRAL] One moment, let me see what we got here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so yeah, I'm not showing any claims on file for that date of service for [PII].
[CUSTOMER][NEUTRAL] OK, I wanna make sure that we've got the correct coverage here. Um, uh, uh, first off, I just wanna verify, did he have coverage on the date of service?
[AGENT][NEUTRAL] Yeah, I believe he was still active. Let's take a look. Yeah, remember, let's see, oh.
[AGENT][NEUTRAL] Actually, the effective date on this one is [PII]. Let me see if there was another plan.
[AGENT][NEUTRAL] The member was active at the time of service. It was under a different plan number. Let me check that one just to make sure that there's nothing there.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like we did actually receive the claim under the active policy at the time of service, uh, the claim was denied we need the explanation of benefits from the primary.
[CUSTOMER][NEUTRAL] OK, um, we did receive an explanation of benefits from Cigna. Is that the primary that you're showing that you need that from?
[AGENT][NEUTRAL] You know what, we actually don't have that information, so you would need to check with the insured, but yeah, that would be what we needed if that's our primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and how would we submit that to you? Do you have a fax?
[AGENT][POSITIVE] Yeah, absolutely, the fax number whenever you're ready.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is [PII].
[CUSTOMER][NEUTRAL] That was [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK perfect and then I just wanna verify um
[CUSTOMER][NEUTRAL] I guess um in order to check on this claim going forward, should we have that other plan number? is that something?
[AGENT][POSITIVE] Yeah, I, I can give it to you, absolutely, yeah, it might be easier.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, that number was 0236.
[AGENT][NEUTRAL] 982 8.
[CUSTOMER][NEUTRAL] That was 02369828.
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[CUSTOMER][POSITIVE] OK, awesome. All right, I will, um.
[CUSTOMER][NEUTRAL] Of course it's that hang on.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] I have, I have a little one of those little e notebook guys, so it's no problem. I got it back. OK, all right.
[AGENT][NEUTRAL] Uh yeah, OK.
[CUSTOMER][POSITIVE] I think we're in good shape. I just need a reference number if that if you offer us any.
[AGENT][NEUTRAL] Anything else?
[AGENT][NEUTRAL] Yeah, absolutely. So call reference is actually my name with my last initial and then today's date. My name again is [PII] spelled [PII] [PII].
[CUSTOMER][POSITIVE] OK, thank you so much, [PII].
[AGENT][POSITIVE] You're welcome have a great day.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][NEUTRAL] Bye bye.