AccountId: 011433970860
ContactId: 057272f0-9aa1-473e-896f-0bdece9e2b70
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 281320 ms
Total Talk Time (AGENT): 122656 ms
Total Talk Time (CUSTOMER): 83488 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/057272f0-9aa1-473e-896f-0bdece9e2b70_20250331T19:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. This is [PII] calling from Rover's office.
[AGENT][NEUTRAL] Hello, [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Actually, I'm looking for a claim status and uh it's a general claim status and I just want to know also the patient active for the details service or not, the policy.
[AGENT][NEUTRAL] Um, yes, sir. I can assist you with policy information and claim status. Could I get a good callback number first just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it's gonna be [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you, Coer. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] Sure. Uh, it's gonna be 022. It's 02449066 M as in Mary, L as in Lima, number 8.
[AGENT][NEUTRAL] Can you please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Sure, the patient's name, [PII].
[CUSTOMER][NEUTRAL] And the member's date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And just let me advise you that verification of coverage does not guarantee payment of claims. Um, I'm showing the effective date on this policy was [PII] and the policy is still active. So what's the date of service and bill charges on the claim?
[CUSTOMER][NEUTRAL] [PII] and the total charge amount $743.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] You said [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII]. It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what are the bill charges again, please?
[CUSTOMER][NEUTRAL] 743 $743.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, yes, sir. We received that claim on, we received the claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[AGENT][NEUTRAL] The claim number is 3573293.
[AGENT][NEUTRAL] And the reason why this claim is denied is because according to the diagnosis code, um, the charges are not covered under the policy.
[AGENT][NEUTRAL] The charges would have to be related to an illness or an injury, and these charges are related to screenings and um
[AGENT][NEUTRAL] Yeah, they're related to screenings and that's not covered under this policy. It has to be related to an illness or an injury.
[CUSTOMER][NEUTRAL] OK. You mean the uh screening services are not good under member's plan, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Can you please check uh the
[CUSTOMER][NEUTRAL] Total claim bill under the same DX I mean for the screening.
[AGENT][NEUTRAL] What's your question?
[AGENT][NEUTRAL] Again, please.
[AGENT][NEUTRAL] Please repeat the question.
[CUSTOMER][NEUTRAL] Yes. Actually, I'm stating that uh we have uh
[CUSTOMER][NEUTRAL] For this claim as a patient responsibility which is $35 copay.
[AGENT][NEUTRAL] Yes, sir, would be whatever the whatever the charges are would be patient responsibility because um it's not covered under this policy. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] I mean, the patient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, the claim number would be 3573293, right?
[AGENT][NEUTRAL] Yes, sir, that's the claim number.
[CUSTOMER][NEUTRAL] OK. Could you please spell your name for me?
[AGENT][NEUTRAL] My name is spelled [PII] and my last initial is [PII], and my name in today's date is your reference number. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] No, thank you so much. Thanks for helping me today. Have a nice day.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL. Mm bye.