AccountId: 011433970860
ContactId: fadc79a0-d944-4807-9352-6f44b637e6a3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 288869 ms
Total Talk Time (AGENT): 149113 ms
Total Talk Time (CUSTOMER): 79582 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/fadc79a0-d944-4807-9352-6f44b637e6a3_20250109T19:21_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I'm calling for claim status.
[AGENT][NEUTRAL] OK, you said your name is [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][NEUTRAL] OK, thank you. And [PII], oh, I'm I'm so sorry. I did not mean to talk over you. You said [PII].
[CUSTOMER][NEUTRAL] Last initial [PII].
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. And your callback number, please?
[CUSTOMER][NEUTRAL] [PII], no extension.
[AGENT][NEUTRAL] OK, thank you and you did say you're needing claim status, correct?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Yes ma'am, I can help you with that. And [PII], what is the member's policy number that you're calling about?
[CUSTOMER][NEUTRAL] It is 0173.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] 7732 M as in Mary, L as in Lucy 7.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and any information [PII] that I provide for you today will be a verification of benefits and not a guarantee of payment. What is the patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her, please?
[CUSTOMER][NEUTRAL] [PII] total billed $417.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEGATIVE] OK, so this claim has been received multiple times, um, for her [PII] and the last 3 times it's been OK, I was gonna say because it's been denied as duplicate.
[CUSTOMER][NEUTRAL] What's the original one.
[AGENT][NEUTRAL] Um, the most recent one, the original claim number, give me one second and I can provide that for you. It was received on 10-1-2024.
[AGENT][NEUTRAL] Processed on [PII].
[AGENT][NEGATIVE] It was denied.
[AGENT][NEUTRAL] And the reason for the denial is that office visits are not covered.
[AGENT][NEUTRAL] Under this supplemental policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, has anyone ever
[CUSTOMER][NEUTRAL] I was thinking that you didn't get the, I was thinking you didn't get the EOB so that's why you have it so many times sorry.
[AGENT][NEUTRAL] No, that's OK. No, it's but we receive claims all but trust me, we receive claims multiple times a lot, so this is definitely not unusual, but yes ma'am, it was, um, that was the reason for the initial denial on here. Now, are you familiar with our portal, [PII]?
[AGENT][NEUTRAL] Where you can actually, OK, we have a portal that you can set up a profile in and you should be able to use that claim number that I gave you to have access to that original EOB mhm it is 3513513672.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEGATIVE] I didn't get the claim number.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the website that you would go to for our portal.
[AGENT][POSITIVE] I secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, I have secured um [PII].
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Mhm. Yes, ma'am. That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well [PII], if I could get a call reference number, that's the only thing I would need to.
[AGENT][NEUTRAL] OK. Well, you will actually use my name along with today's date.
[CUSTOMER][POSITIVE] Sounds great thank you so much for your assistance and you have a wonderful rest of your day.
[AGENT][POSITIVE] Absolutely, yes ma'am. Well, I hope you do too, and thank you again [PII] for calling APL.
[CUSTOMER][POSITIVE] Thank you mhm bye bye.
[AGENT][NEUTRAL] All right. Bye-bye.