AccountId: 011433970860
ContactId: f23995e1-6599-4906-af05-811403ca3c19
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 567419 ms
Total Talk Time (AGENT): 151701 ms
Total Talk Time (CUSTOMER): 158959 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/f23995e1-6599-4906-af05-811403ca3c19_20250210T16:08_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], this is [PII] calling from the provider's office to check on a claim status.
[AGENT][POSITIVE] OK, I'm happy to check on a claim for you today [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] Sure, before that I would like to inform you that this call is being recorded for training and quality purposes. Is that fine?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. The policy number is 016.
[CUSTOMER][NEUTRAL] 349
[CUSTOMER][NEUTRAL] 12 M as in Mike L as in Lima number 7.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you so much. And then what is the data service?
[CUSTOMER][NEUTRAL] The service is [PII].
[AGENT][NEUTRAL] Build about?
[CUSTOMER][NEUTRAL] It's $200 even.
[AGENT][POSITIVE] Alright thank you one moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you for your patience on that. So it looks like we did receive the claim. The claim was received [PII].
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim was denied we requested a copy of the primary EOB.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This was denied on [PII].
[CUSTOMER][NEUTRAL] Actually we have submitted the primary OB via fax.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Not showing anything on file. You wanna verify the fax number?
[CUSTOMER][NEUTRAL] I'm sorry, uh, it was actually sent, uh, through mail.
[AGENT][NEUTRAL] Was it sent to [PII]?
[CUSTOMER][NEUTRAL] Uh, just a moment please.
[CUSTOMER][NEUTRAL] No, it was sent to [PII].
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEGATIVE] I don't show anything on file it needs to be resent.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please give me the fax number?
[AGENT][NEUTRAL] 877.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][POSITIVE] 23. OK, thank you so much.
[CUSTOMER][NEUTRAL] And the claim was denied on?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get the claim number, please?
[AGENT][NEUTRAL] 351.
[AGENT][NEUTRAL] 7322.
[CUSTOMER][POSITIVE] OK, thank you so much and the reference number?
[AGENT][NEUTRAL] Call references my name with my last initial then today's date. My name is [PII], that's [PII] Last initial is [PII].
[CUSTOMER][POSITIVE] OK, thank you so much sir uh [PII].
[CUSTOMER][NEUTRAL] Can you please help me with one more claim?
[AGENT][NEUTRAL] Anything else?
[AGENT][NEUTRAL] Yeah, absolutely. Same policy or different?
[CUSTOMER][NEUTRAL] It's a different policy.
[AGENT][NEUTRAL] OK, policy number when you're ready.
[CUSTOMER][NEUTRAL] Yeah, it's uh 021.
[CUSTOMER][NEUTRAL] 4541
[CUSTOMER][NEUTRAL] Number 5, M as in Mike, L as in Lima, and the number 8.
[AGENT][NEUTRAL] What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][POSITIVE] Thank you and date of service?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[CUSTOMER][NEUTRAL] And the total bill amount is $572 even.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim was denied requesting copy of primary EOB.
[CUSTOMER][NEUTRAL] And when was the claim denied?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The claim number?
[AGENT][NEUTRAL] 351.
[AGENT][NEUTRAL] 6707.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The reference number for this will be your name and today's date.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, shall I proceed with the next one?
[AGENT][NEUTRAL] Yes, one moment.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] The member ID is 982,310.
[AGENT][NEUTRAL] A patient name and date of birth?
[CUSTOMER][NEUTRAL] It's uh [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Date of service is [PII].
[AGENT][NEUTRAL] Build them out.
[CUSTOMER][NEUTRAL] It's $276 even.
[AGENT][NEUTRAL] Not showing any claims on file for that date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, uh, can I get the mailing address, please?
[AGENT][NEUTRAL] Uh, claims mailing address is [PII].
[AGENT][NEUTRAL] That's in [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 24, OK.
[AGENT][NEUTRAL] The patient is not active. They haven't been active since [PII].
[CUSTOMER][NEUTRAL] OK, so you're saying that the patient is not active.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, fine, thank you so much for the information.
[CUSTOMER][NEUTRAL] Can I get the
[CUSTOMER][NEUTRAL] Uh, term date and the start date of the policy.
[AGENT][NEUTRAL] Effective date, [PII].
[AGENT][NEUTRAL] Terminated [PII].
[CUSTOMER][POSITIVE] OK, thank you so much, [PII].
[AGENT][NEUTRAL] Mhm. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Yeah, I don't need the.
[CUSTOMER][NEUTRAL] Afield's mailing address. Is it the same?
[AGENT][NEUTRAL] It is the same, uh-huh.
[CUSTOMER][POSITIVE] OK, thank you so much, sir. Have a great day ahead.
[AGENT][NEUTRAL] You too, bye.
[CUSTOMER][NEUTRAL] Bye bye.