AccountId: 011433970860
ContactId: e9869a8b-b285-44bc-8fe1-d81beb892081
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 253899 ms
Total Talk Time (AGENT): 76704 ms
Total Talk Time (CUSTOMER): 67719 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/e9869a8b-b285-44bc-8fe1-d81beb892081_20250317T13:53_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] Hi, [PII], this is [PII] calling the provider's office to check on the claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII]. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] I just have one claim to work on.
[AGENT][NEUTRAL] All right. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Policy number is 01780690.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[CUSTOMER][NEUTRAL] Your name is [PII], sorry, it's [PII] Last name is [PII]. It's [PII] sorry. And the date of birth is [PII].
[AGENT][NEUTRAL] And 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 bill for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Oh yes.
[CUSTOMER][NEUTRAL] of service is [PII].
[CUSTOMER][NEUTRAL] And for this one, the total charge amount is
[CUSTOMER][NEUTRAL] $16,719 and even.
[AGENT][NEUTRAL] $16,719.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 351-3902.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting an explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thank you. And can you please tell me how can you send this? Do you have any fax number for this?
[AGENT][NEUTRAL] Sure, um, our fax number is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 942 [PII].
[CUSTOMER][NEUTRAL] And is what will be the TFL for those?
[AGENT][NEUTRAL] There's no timely filing limit as long as the policy is active on the data service, you can file the claim at any time.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] How about you give my side to see if we have previously sent out the claim or fax. Can you check whether you have, you have received that or not?
[AGENT][NEUTRAL] I'm sorry, you said you sent the claim by fax?
[CUSTOMER][NEUTRAL] Uh, no. Uh, we have sent the EOB. Can you check whether you have received that or not?
[AGENT][NEUTRAL] Yes, we have, let me, we received another claim. Let me see if the explanation of benefits is on there because it was denied as a duplicate. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold, Mark?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.