AccountId: 011433970860
ContactId: f08ee847-4db7-43c8-8939-524b82023c4c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 447260 ms
Total Talk Time (AGENT): 178341 ms
Total Talk Time (CUSTOMER): 95264 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/f08ee847-4db7-43c8-8939-524b82023c4c_20250421T15:12_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is I'm calling from Prisma Health University Medical Group calling for claim status on a patient.
[AGENT][POSITIVE] OK, and I do apologize. May I have your name again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you so much and your callback number please.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you very much and may I have the policy number please?
[CUSTOMER][NEUTRAL] Sure, it is D43722079.
[AGENT][NEUTRAL] OK, I'll have to look the member up by different means. Give me one moment please. I'm gonna ask you for the member's last name and first.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you so much and may I have the last name?
[CUSTOMER][NEUTRAL] [PII] is the last name of the policyholder.
[AGENT][NEUTRAL] OK, thank you and the first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and bear with me please.
[CUSTOMER][NEUTRAL] This is for his wife, [PII].
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Would you happen to have the group number please, [PII]?
[CUSTOMER][NEUTRAL] Have 1000.
[CUSTOMER][NEUTRAL] Listed for
[CUSTOMER][NEUTRAL] The group.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But not a name, just other.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] I'm not showing him in our system. um, I'm still looking though um what is the state of residency please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK, still searching. OK, bear with me. Let me have it here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, still searching thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] Would you happen to have [PII]'s date of birth, perhaps?
[CUSTOMER][NEUTRAL] Yes, um,
[CUSTOMER][NEUTRAL] Oh, no, I don't think so. It's got [PII], which means that we don't have his date of birth, typically.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, no problem, I'm still searching.
[CUSTOMER][NEUTRAL] Let me see if I can find it in the zoo.
[AGENT][NEUTRAL] Um let's see here.
[AGENT][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] OK, I believe I have it here and what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] I was able to find the policy for the member. Let me provide you with the policy number for APL because it would be different from what that you provided me. Excuse me, I'm so sorry, Ms. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The one that I have.
[AGENT][NEUTRAL] Yes, it's different from that. The policy number is 02596440.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and you're calling for claim status and what is the date of service and total charge amount please?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] $34 on [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Did I say 34. Yeah.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And that was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] $34 OK.
[AGENT][NEUTRAL] OK, I show that we received the claim and just to verify if you could provide that procedure code please.
[CUSTOMER][NEUTRAL] 93,010.
[AGENT][NEGATIVE] OK, yes ma'am. Thank you. Uh, it was received and denied. It shows that the policy is a limited policy and it does not cover for inpatient doctor visits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How can I get that denial?
[AGENT][NEUTRAL] OK, you're able to obtain ELBs from our website at [PII], but I'll be more than happy to fax over the EOB to you for this state of service. What is your fax number please, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and let me just repeat that to confirm. I have that as [PII].
[CUSTOMER][POSITIVE] Yes, that's perfect.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, thank you. I will get that faxed over and I can go ahead and provide you with that claim number, but of course it'll be on the EOB.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. The claim number is 358838-5.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Alright, and a call reference number?
[AGENT][NEUTRAL] We do not use call reference numbers [PII], but you can use my name [PII] last initials [PII] and today's date and will there be anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's all I had. Thank you.
[AGENT][POSITIVE] You're welcome, [PII], and thank you for calling APL. Have a good week. Thank you.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] OK, bye.