AccountId: 011433970860
ContactId: ebb64e0e-6ca1-4a29-a3a3-73e00045dd6f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 289420 ms
Total Talk Time (AGENT): 115843 ms
Total Talk Time (CUSTOMER): 94437 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/ebb64e0e-6ca1-4a29-a3a3-73e00045dd6f_20250307T21:09_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. I'm looking for a claim status.
[AGENT][NEUTRAL] OK, well I can help you with the claim status and if I may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. Could you please spell your name?
[AGENT][NEUTRAL] Yes, my name is [PII], [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure, it's uh 01.
[CUSTOMER][NEUTRAL] 997,050.
[AGENT][POSITIVE] Thank you and a good contact number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, ma'am, the first name is [PII] Last name is [PII] Date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim and the total bills?
[CUSTOMER][NEUTRAL] Yeah, it's been on [PII]. Bill amounts 1050, 1050.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mm yeah.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] So, I'm not showing a claim on file for [PII].
[CUSTOMER][NEUTRAL] No, it's 2024.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] All right, and I located the claim. My apologies. Hold on one moment.
[CUSTOMER][POSITIVE] Yeah, sure, take your time.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, it's anesthesiology affiliates LLC.
[AGENT][NEUTRAL] So I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 3,449,310.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied requesting the explanation of benefits from primary insurance?
[CUSTOMER][NEUTRAL] OK. And who's the primary insurance?
[AGENT][NEUTRAL] Primary is Allstate benefits?
[CUSTOMER][NEUTRAL] Oh my [PII]
[CUSTOMER][NEUTRAL] Allstate, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, but in my system, the primary insurance showing is elite benefit of First Health. Can you check? Um,
[AGENT][NEUTRAL] So, let me double check, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, so they may have another insurance, but this Medlink policy is second only to Allstate benefits.
[CUSTOMER][NEUTRAL] OK, so you have the details of Allstate.
[AGENT][NEUTRAL] No, we only have the name. Um, you'll have to get that information from the insured. We, we just have the name of the insurance company.
[CUSTOMER][NEUTRAL] well
[CUSTOMER][NEUTRAL] OK. Uh, so you have the, uh, Allstate ID?
[AGENT][NEUTRAL] We only have the, we only have the name of the major medical company. We don't have any other information, so you'll have to get that from the insured.
[CUSTOMER][NEUTRAL] Member ID?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You, you don't have any details about the Allstate, right?
[CUSTOMER][POSITIVE] OK, no issues. Uh.
[CUSTOMER][NEUTRAL] And uh you don't have the last UP updated details for this, ma'am, uh, Allstate?
[AGENT][NEUTRAL] The only coordination of benefits is that Allstate is primary and the Medlink or the APL policy is second to Allstate only.
[CUSTOMER][NEUTRAL] OK. Fine, no issues. And what was your call reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, and again, the first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK fine, no issues thank you thank you so much.
[AGENT][NEUTRAL] You're welcome, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Uh, no, fine. Thank you.
[AGENT][POSITIVE] Alright, thanks for calling APL. You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] Yeah bye.