AccountId: 011433970860
ContactId: e9c9ccc8-348c-44e9-ae70-31d92858820c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 222740 ms
Total Talk Time (AGENT): 109639 ms
Total Talk Time (CUSTOMER): 54983 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/e9c9ccc8-348c-44e9-ae70-31d92858820c_20250207T15:37_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm with SSM Healthcare Group. I want to check on the status of a claim.
[AGENT][NEUTRAL] OK, [PII], you have one claim that you're needing status on, is that correct?
[CUSTOMER][NEUTRAL] That's it, one claim, yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number please?
[CUSTOMER][NEUTRAL] 01828769
[AGENT][POSITIVE] Thank you. One moment, please.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] This is for [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is your date of service and total bill amount for him, please?
[CUSTOMER][NEUTRAL] 5624.
[CUSTOMER][NEUTRAL] Uh, for $98.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so you said it was for [PII].
[CUSTOMER][NEUTRAL] No, 5656.
[AGENT][NEUTRAL] 0 56.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so the most recently received claim was denied as a duplicate of previously submitted expenses. Do you need that information or the original claim?
[CUSTOMER][NEUTRAL] Uh-huh, what happened with the original plan?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] The original claim number is 3,469,160.
[AGENT][NEUTRAL] And the reason for the ma'am?
[CUSTOMER][NEUTRAL] I still.
[CUSTOMER][NEUTRAL] Go ahead, go ahead.
[AGENT][NEGATIVE] This was denied and the reason for the denial, it states that based on information included on the claim form, this service was not rendered in a covered place of service as outlined in the policy contract. For this reason, we are unable to provide benefits for this charge.
[CUSTOMER][NEUTRAL] So which meant that it had been patient responsibility.
[AGENT][NEUTRAL] We do not determine patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and you said that they did not because of the place of service not covered on the patient's policy.
[AGENT][POSITIVE] Yes that is correct. It says.
[CUSTOMER][POSITIVE] Thank you so very much Trace is [PII] going? Thanks a lot, [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Oh, [PII], yes ma'am, and if you need a copy, [PII], of this explanation of benefits for this member, we do have a portal, but now that you have a claim number, you should be able to print that from them.
[CUSTOMER][NEUTRAL] Huh.
[AGENT][NEUTRAL] And our portal website is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty thank you so much [PII] and have a great day.
[AGENT][POSITIVE] You are so yes ma'am you too and thank you again for calling.