AccountId: 011433970860
ContactId: f03510df-8ccc-4405-860c-7d8d565868f0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 371190 ms
Total Talk Time (AGENT): 117399 ms
Total Talk Time (CUSTOMER): 141877 ms
Interruptions: 4
Overall Sentiment: AGENT=1.1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/f03510df-8ccc-4405-860c-7d8d565868f0_20250408T18:27_UTC.wav
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[AGENT][POSITIVE] Good afternoon thank you for calling APL.
[AGENT][NEUTRAL] This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider office. Hi, this is [PII] calling from provider office for claim status.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Hey [PII], you're needing to check claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][NEUTRAL] I'm sorry. Can you start again? OK, what's
[AGENT][NEUTRAL] Let's start again. What are the 1st 3 numbers?
[CUSTOMER][NEUTRAL] 4
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry. I'm sorry, [PII], I'm not.
[CUSTOMER][NEUTRAL] And not
[AGENT][NEUTRAL] Able to understand
[AGENT][NEGATIVE] Yes, sir. I'm not able to understand you. Our connection is not very good.
[CUSTOMER][NEUTRAL] to understand.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you have to check status on today?
[CUSTOMER][NEUTRAL] I have only one claim.
[AGENT][NEUTRAL] OK, and what is that member's policy number, please?
[CUSTOMER][NEUTRAL] 023-34237.
[AGENT][NEUTRAL] Thank you, one moment please, while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] that. Yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] And any information [PII] that I provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] I'll call you today.
[CUSTOMER][NEUTRAL] It's a patient named [PII]. Date of birth, [PII].
[AGENT][POSITIVE] Thank you and the date of service and total bill amount for her, please.
[CUSTOMER][NEUTRAL] So date of service on [PII] and the amount $7,169 even.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, so this claim was received on [PII].
[CUSTOMER][NEUTRAL] This claim was on [PII].
[AGENT][NEUTRAL] And that was reprocessed and denied on [PII].
[AGENT][NEUTRAL] The claim number?
[AGENT][NEUTRAL] It's 358-003-1.
[AGENT][NEUTRAL] And the reason for the denial on this claim, [PII], states outpatient benefit for this calendar year has been met.
[AGENT][NEUTRAL] [PII], are you still there?
[CUSTOMER][NEUTRAL] Yes, uh, the, the balance is patient deductable.
[AGENT][NEUTRAL] We are you asking about patient responsibility?
[CUSTOMER][NEUTRAL] We are you asking about who responsibility?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The uh the balance is patient responsibility.
[AGENT][NEUTRAL] We do not
[AGENT][NEUTRAL] We do not determine patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] We do have this
[CUSTOMER][POSITIVE] We have time and patient respoil to the provider. OK.
[CUSTOMER][NEUTRAL] May the reference numbers.
[AGENT][NEUTRAL] And if you need a copy, yes, my name that I gave you along with today's date, and if you need a copy of the explanation of benefits, you may print that [PII] by going to secured.
[CUSTOMER][NEUTRAL] And if you need a car and then I.
[CUSTOMER][NEUTRAL] Yeah, OK. May I know your name, please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Pricing.
[CUSTOMER][POSITIVE] Good, thank you.
[AGENT][POSITIVE] You're welcome. And is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Thank you. Thanks for your assistance.
[AGENT][POSITIVE] OK, [PII], well, you're welcome and thank you for calling APL. I hope you have a nice rest of your day.
[CUSTOMER][POSITIVE] I hope you have a nice rest of your day.