AccountId: 011433970860
ContactId: ec77fc96-1f8e-4557-abe4-a2f16a913058
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 250470 ms
Total Talk Time (AGENT): 117931 ms
Total Talk Time (CUSTOMER): 57297 ms
Interruptions: 1
Overall Sentiment: AGENT=2.6, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/ec77fc96-1f8e-4557-abe4-a2f16a913058_20250107T13:21_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, good morning [PII]. My name is [PII] and I'm calling to check claim status.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and [PII], what is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] Um, I have 01612256.
[AGENT][NEUTRAL] OK, thank you, give me a moment to get the member's information pulled up please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of er excuse me, what is the date of service and total bills amount, please?
[CUSTOMER][NEUTRAL] [PII] and billed amount was $5,083.60.
[AGENT][NEUTRAL] 55083.60, is that correct?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do see that there was a claim received for him. This claim was actually received on [PII]. It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3546049.
[AGENT][NEUTRAL] And the reason for the denial on this claim Mar states these services were rendered after coverage was terminated.
[AGENT][NEUTRAL] This member's policy terminated [PII].
[CUSTOMER][NEUTRAL] OK, so it terminated [PII].
[AGENT][POSITIVE] Yes ma'am, that is correct.
[CUSTOMER][NEUTRAL] Got it. OK, alright, um, and just to verify you said claim claim number was, oh, I'm so sorry.
[AGENT][NEUTRAL] And then
[AGENT][POSITIVE] Oh, I'm so sorry. Mhm. I'm sorry.
[CUSTOMER][NEUTRAL] It's OK, um, so claim number was 3546049.
[AGENT][NEUTRAL] Yes ma'am, that is correct and if you need a copy of that EOB we do have a portal in which you can create a username and password to have access to that and that website is [PII].
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it. OK, alright, well thank you very much.
[AGENT][POSITIVE] OK, and is there, yes, ma'am, you're certainly welcome. And is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] Um, no, if I can just get a reference, uh, for the call today.
[AGENT][NEUTRAL] Sure, you would use my name along with today's date.
[CUSTOMER][POSITIVE] Got it OK alright well thank you so much I appreciate your help.
[AGENT][POSITIVE] Well, you are very welcome. And again, thank you for calling APL. I hope you have a very nice day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] Yes ma'am. Thank you. Bye.