AccountId: 011433970860
ContactId: 08cf4967-2741-4b4d-8c83-66659fc706bb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 165300 ms
Total Talk Time (AGENT): 62936 ms
Total Talk Time (CUSTOMER): 71973 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/08cf4967-2741-4b4d-8c83-66659fc706bb_20250221T19:17_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, I'm calling to check on a claim please.
[AGENT][POSITIVE] I'll be more than happy to help you with the claim status. May I have your name and a good contact number?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII]. It's spelled [PII] and my phone number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it is 01904346 M as in Mary, L as in Lima, and 8, the number 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It is a 4, let me just get it right here. [PII]'s birth date is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] You bet it is [PII] billed amount of $535.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Sure, it is under Orlando Health Medical Group. The actual provider is Yaman Samadi.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 353.
[AGENT][NEUTRAL] 683 2.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome, and on [PII], the claim was denied because office visits are not covered on this policy.
[CUSTOMER][NEUTRAL] OK, is there any adjustments or is it all patient responsibility?
[AGENT][NEUTRAL] Um, we don't determine patient responsibility because we're not the major medical insurance company.
[CUSTOMER][NEUTRAL] Sure, of course. I do see that he has other insurance. Did you need that EOP from the other insurance or did you get it already?
[AGENT][NEUTRAL] Yes, we have the, um, we have the EOB to process the claim.
[CUSTOMER][NEUTRAL] OK, super, all right, and then let me get a reference number for our call.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name um and today's date. So my name is [PII], [PII] [PII], and then today's date.
[CUSTOMER][POSITIVE] Perfect. Thank you so much. Have a great day.
[AGENT][POSITIVE] Thank you, [PII] you also, and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm bye bye.