AccountId: 011433970860
ContactId: fb9844f0-d0f4-420c-84d9-a4f9bf028df4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 426489 ms
Total Talk Time (AGENT): 165257 ms
Total Talk Time (CUSTOMER): 124719 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/fb9844f0-d0f4-420c-84d9-a4f9bf028df4_20250612T16:03_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEGATIVE] Yes, I am calling to check on a claim that was denied.
[AGENT][NEUTRAL] OK, sure. I can assist you with claims and may I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], and Miss [PII], are you calling for a provider's office or this is your personal policy?
[CUSTOMER][NEUTRAL] Provisor's office.
[AGENT][NEUTRAL] OK. May I have the name of the provider's office or the facility and a callback number just in case.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] Picayune smiles.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] It's picking and m [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] 02623675
[AGENT][NEUTRAL] OK. Thank you. One moment.
[AGENT][NEUTRAL] Is that, um, is that a social?
[AGENT][NEUTRAL] Mm, I it's missing attention. Mm mm. Um, do you have any other numbers? Uh, it's a little bit too long to be one of our policy numbers.
[CUSTOMER][NEGATIVE] Mm no.
[CUSTOMER][NEUTRAL] That might be why y'all can't find them. Let me see, um, hold on, let me.
[CUSTOMER][NEUTRAL] Uh, of course I don't have a social. Let's see, let me see what number.
[CUSTOMER][NEUTRAL] So [PII].
[CUSTOMER][NEUTRAL] Let me see if I have, I don't think they gave us an insurance card either.
[CUSTOMER][NEUTRAL] This is the number they gave us.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] And we can do a name search.
[CUSTOMER][NEUTRAL] Um, uh, let's.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] I just
[CUSTOMER][NEUTRAL] Last name is [PII], and he's a junior. I don't know if that matters.
[AGENT][NEUTRAL] You said it was [PII], correct?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you know the address?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, let me take the junior off. I didn't find one in [PII] with Junior.
[CUSTOMER][NEUTRAL] I have a group number and name.
[AGENT][NEUTRAL] Let me see the group, let me have the group number.
[CUSTOMER][NEUTRAL] 70101.
[AGENT][POSITIVE] Superior skill trains.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, that is a large group, so it's gonna take a few minutes to pull all the names, OK? One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] I preferred.
[AGENT][NEUTRAL] You I.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Do you
[AGENT][NEUTRAL] What is his date of birth?
[CUSTOMER][NEUTRAL] Give me one second. Oh my god um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, yeah, in.
[AGENT][NEUTRAL] All right, let's see and what is um the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh, the first, well, this one is gonna be for his wife.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] It was for 292 on [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And on him he had one for [PII].
[CUSTOMER][NEUTRAL] Um, total was 160.
[CUSTOMER][NEUTRAL] That was so not the total.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let me see what his was 2391.
[AGENT][NEUTRAL] OK. Let me pull [PII] first. It looks like [PII] paid.
[AGENT][NEUTRAL] Um, this is still in um under review.
[CUSTOMER][NEUTRAL] Yeah, we got an EOB stating that benefit name not sound.
[AGENT][NEUTRAL] Um, the denial reason is going to be that um we're waiting to confirm eligibility, and that's the correct denial reason.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Is there a different group number that we, I mean different member ID number?
[AGENT][NEUTRAL] Mm. No, the, the policy number instead of a 6, it doesn't start with a 6. It starts with a 2, 262-367-5 is the number.
[CUSTOMER][NEUTRAL] So don't put the 0 on the front?
[CUSTOMER][NEUTRAL] Because I have 02623675.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] Yes, without the 0.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So, um, yeah, basically on the back of that, uh, explanation of benefits, you're gonna see the remorse code and it's just indicating that we're waiting information to confirm eligibility. So that is the um to know reason for his claim, um.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] For the let me see.
[AGENT][NEUTRAL] Looks like for [PII], we are ready to send that payment. Let me see when we send that payment.
[AGENT][NEUTRAL] Uh, oh, we're getting ready to send the payment, so they're processing today.
[CUSTOMER][NEGATIVE] Oh OK so just avoid this letter.
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][POSITIVE] OK, thank you very much.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today, Miss [PII]?
[CUSTOMER][NEUTRAL] Yeah, what is, what was your name again?
[AGENT][NEUTRAL] My name is [PII]. That's [PII], that's initial [PII].
[CUSTOMER][NEUTRAL] And the you have a reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][POSITIVE] OK great thank you very much.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Have a good day, Miss [PII].
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] No