AccountId: 011433970860
ContactId: 063afb32-b1b2-46d0-86b1-e8988f5c4930
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 466059 ms
Total Talk Time (AGENT): 126379 ms
Total Talk Time (CUSTOMER): 138159 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/063afb32-b1b2-46d0-86b1-e8988f5c4930_20250613T15:16_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from provider's office. Can you help me with the claim status, please?
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with the claim status, [PII], and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Only one claim.
[AGENT][NEUTRAL] Alright, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] I'm sorry, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] No, it's, no, no. It's [PII].
[AGENT][NEUTRAL] Can you say
[AGENT][NEUTRAL] OK, [PII], I'll just put all the numbers together and then break it down. Can you repeat them? [PII].
[CUSTOMER][NEUTRAL] No. The starting number is [PII].
[AGENT][NEUTRAL] Thank you. May I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it's 59.
[CUSTOMER][NEUTRAL] 355-7505
[AGENT][NEUTRAL] Do you have their APL policy number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Or is this a social?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is this their social? OK.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] One second, I'm checking.
[CUSTOMER][NEUTRAL] Yeah, I have the social.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Yes, that's the number you just provided. Hold on one moment, I'm searching for it now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the member's first and last name?
[CUSTOMER][NEUTRAL] need
[CUSTOMER][NEUTRAL] 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.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So the policy number is 233.
[CUSTOMER][NEUTRAL] CIA.
[AGENT][NEUTRAL] 72
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] 84
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It's [PII], and the total bill amount is $1,066 even.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] You remember secondary of.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It's Florida ENT Associates.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII], I'm sorry, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 360.
[AGENT][NEUTRAL] 97
[AGENT][NEUTRAL] 89
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Code 992.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 14 was denied because office visits are not covered by this policy?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Code 31575 and 31231 were denied.
[AGENT][NEUTRAL] Because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And the member benefits, member won't have any office visit benefits?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Uh.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK, got it. Thank you. Can you provide me the call reference number, please?
[AGENT][NEUTRAL] You're welcome. So there's no call reference number, but you can use my name in today's date. And again, that's [PII].
[CUSTOMER][NEUTRAL] OK. Before disconnecting the call, can you fax me the EOB please?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And is that attention, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, is it alright if I place you on just a brief hold while I fax the explanation of benefits to you?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. So I've faxed the explanation of benefits over for you. Was there anything else I can assist you with today?
[CUSTOMER][NEGATIVE] No, thanks.
[AGENT][POSITIVE] Alrighty well thank you so much for calling APL. I hope you have a great weekend.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] Thank you bye bye.