AccountId: 011433970860
ContactId: 0127ed90-f1ed-4a8e-bd21-e2ae37540685
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 653799 ms
Total Talk Time (AGENT): 131235 ms
Total Talk Time (CUSTOMER): 153877 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/0127ed90-f1ed-4a8e-bd21-e2ae37540685_20250326T20:43_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Proda office. I want to check the claim status.
[AGENT][NEUTRAL] Sure, I can assist you with claim status, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. May I have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Nicholas, Children Pediatrics.
[AGENT][NEUTRAL] OK, and may I have the patient's policy number Mr. [PII]?
[CUSTOMER][NEUTRAL] 02462340. M as in Mike, Lima, and the number 8.
[AGENT][NEUTRAL] All right. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. What's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] $1,252.38.
[AGENT][NEUTRAL] Right. That was [PII] for $1,252.38 correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me see if I can find this claim. For future, you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] Let me pull this ELB, OK. One moment.
[CUSTOMER][NEUTRAL] Uh, yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm waiting on the system, bear with me.
[AGENT][NEUTRAL] OK, so it looks like we processed this claim on [PII] and the claim was denied. The reason for this denial.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is that policy does not have benefits for treatment or condition other than sickness or injury.
[AGENT][NEUTRAL] So preventatives are not covered.
[CUSTOMER][NEUTRAL] So is it under uh member policy?
[AGENT][NEUTRAL] Yes, another member's plan.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] You a clean going how many people.
[CUSTOMER][NEUTRAL] Could you please tell me the uh
[CUSTOMER][NEUTRAL] Claim number?
[AGENT][NEUTRAL] Yes, um, the claim number is 3,553,050.
[CUSTOMER][NEUTRAL] you know.
[CUSTOMER][NEUTRAL] 50 right?
[AGENT][NEUTRAL] Yes, again, that's 3,553,050.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Thank you. OK, uh, please give me a second. Uh, let me just pull up the claim, whether I can check it through, uh, web portal or not. Sometimes we do not get claims.
[AGENT][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] OK, sure, yes.
[AGENT][POSITIVE] Take your time.
[CUSTOMER][POSITIVE] Yeah. OK. Thank you.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And like, uh, without the claim number, uh, we could not uh pull up the claim in the web portal. Why? Do you, do you know the reason?
[AGENT][NEUTRAL] No, I'm not sure why unless um you don't have the social, the last four of the social, which I think that's what it's asking for.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] So, so the claim number is 3,553,050, right?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Me.
[CUSTOMER][NEUTRAL] See, I could, I could, uh, pull up the claim in the web portal, in the API uh portal. Why? Do you have any, uh, different claim number?
[AGENT][NEUTRAL] No, that is the claim number 3,553,050.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, I have the correct one and as I have said, I cannot pull up the claim so that I can uh download the EOB without asking you to fax uh to my friends.
[AGENT][NEUTRAL] What's the fax number?
[CUSTOMER][NEUTRAL] OK. Can you do that? Uh, if you can, I can give you the fax number.
[AGENT][NEUTRAL] Go ahead with the fax number.
[CUSTOMER][NEUTRAL] OK, it's
[CUSTOMER][NEUTRAL] 513993-7441.
[AGENT][NEUTRAL] 51399374441
[CUSTOMER][NEUTRAL] Yes, at the you can put uh attention to my name.
[AGENT][NEUTRAL] Hang on one moment.
[AGENT][NEUTRAL] OK, one moment, let me go ahead and send this out to you, OK? One moment.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. Yeah, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK, could you please tell me your name?
[AGENT][NEUTRAL] My name is [PII]. That's [PII] uh.
[CUSTOMER][POSITIVE] One second, I'm sorry for.
[CUSTOMER][NEUTRAL] [PII] right?
[AGENT][NEUTRAL] Yes, that's [PII] [PII]
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. Could you please tell me the reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date.
[CUSTOMER][POSITIVE] OK, uh, so, uh, that's all for now. Have a nice day. Thank you so much. Bye-bye.
[AGENT][POSITIVE] You as well. Thank you for calling APM. Bye-bye.