AccountId: 011433970860
ContactId: f53eaad3-2995-4d92-b6d0-2b438f4c8cd8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 483359 ms
Total Talk Time (AGENT): 173459 ms
Total Talk Time (CUSTOMER): 136518 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/f53eaad3-2995-4d92-b6d0-2b438f4c8cd8_20250611T12:49_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello [PII], this is [PII] calling from provider's office to check up on the claim status. Also, this call is been recorded for quality and training purposes. Are you OK with that?
[AGENT][POSITIVE] Yes, um, that's fine, and I'll be more than happy to help you with the claim status. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Um, sure, it would be [PII]. And you said your name is [PII]? Is it [PII]?
[AGENT][NEUTRAL] Yes, [PII]
[CUSTOMER][POSITIVE] [PII] OK thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're welcome. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Actually I do have 4 claims with me.
[AGENT][NEUTRAL] OK, are they all the same member or different members?
[CUSTOMER][NEUTRAL] Uh, 2 claims or two data services are for the same member.
[AGENT][NEUTRAL] OK, will you need copies of the explanation of benefits for all the um all of them that we go over?
[CUSTOMER][NEUTRAL] Um, no.
[AGENT][NEUTRAL] All right. May I have the first member's policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 02494313 M as in Mike L as in Lima number 8.
[AGENT][NEUTRAL] Thank you and can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and total bill for the claim?
[CUSTOMER][NEUTRAL] Mm, yes, the detail service is [PII]. Total charge $500 even.
[AGENT][NEUTRAL] OK, does this member have multiple days of service?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what's the second one?
[CUSTOMER][NEUTRAL] Uh, the second one is [PII].
[CUSTOMER][NEUTRAL] Total charge $670 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Yeah, it's uh Midtown Diagnostic Center LLC.
[AGENT][NEUTRAL] Alright, so I'm showing that for the first day of service, [PII], um, this claim was, well, actually both of the claims were received on [PII].
[AGENT][NEUTRAL] For the $500 data service, that claim number is 36093667.
[AGENT][NEUTRAL] For the $670.
[AGENT][NEUTRAL] The claim number is 3609369.
[AGENT][NEUTRAL] Both claims were processed on [PII].
[AGENT][NEUTRAL] And they were denied for the same reason, um, requesting the explanation of benefits from primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Um, OK, sure, thank you so much.
[CUSTOMER][NEUTRAL] Can you help me with the fax number?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, our fax number is [PII].
[AGENT][NEUTRAL] 942 [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Can you also help me with the call reference number and I don't know.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] The call reference number for
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The call reference number for the entire call will be my name and today's date. And again, that's [PII].
[CUSTOMER][POSITIVE] OK, thank you so much. Can we move to next member?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] I'm ready when you are.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The member ID would be 02477.
[CUSTOMER][NEUTRAL] Uh, just a moment.
[CUSTOMER][NEUTRAL] It's 02477075.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Member's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the dates of service and the total bills?
[CUSTOMER][NEUTRAL] Uh, sure, actually I do have a date of service [PII], and for this date of service I do have two claims.
[AGENT][NEUTRAL] OK. And what are the dates, the total bill?
[CUSTOMER][NEUTRAL] The first charge amount is?
[CUSTOMER][NEUTRAL] Yeah, uh, the first charge amount is $500 even.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the second one would be $450 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Oh wait a minute, I reversed it.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so these two claims were also processed on the same day and received on the same day. I received them on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number for the $500 bill is 336.
[AGENT][NEUTRAL] 10
[AGENT][NEUTRAL] 411. I'm sorry. Let me repeat, let me um give that again. It's 3.
[AGENT][NEUTRAL] 61.
[AGENT][NEUTRAL] 0411.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the second one for the $450 is 361-0436.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], they both were processed?
[AGENT][NEGATIVE] And denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][POSITIVE] OK, sure, no problem.
[CUSTOMER][POSITIVE] I can submit this one as well.
[CUSTOMER][POSITIVE] Um, yeah, thank you so much for your help.
[AGENT][POSITIVE] You're welcome. Was there anything else I can assist you with today? All right, well, thanks for calling APL.
[CUSTOMER][NEUTRAL] That's it for the day.
[CUSTOMER][POSITIVE] Uh no, thank you so much.
[AGENT][POSITIVE] I hope you have a great day.
[CUSTOMER][POSITIVE] Bye bye take care.
[AGENT][NEUTRAL] Bye bye.