AccountId: 011433970860
ContactId: 0ab53178-322f-43fd-8036-74a7cfc27ebe
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 485890 ms
Total Talk Time (AGENT): 135369 ms
Total Talk Time (CUSTOMER): 54022 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=-1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/0ab53178-322f-43fd-8036-74a7cfc27ebe_20250620T13:25_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] I'm calling to check the status of a claim.
[AGENT][NEUTRAL] Sure, I can assist you with claim status. May I have your name?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][POSITIVE] Thank you. And may I have a callback number just in case we get disconnected Miss [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And may I have the name of the facility you're calling from for my notes?
[CUSTOMER][NEUTRAL] West County Women's Healthcare.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] 02560304
[AGENT][NEUTRAL] OK. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect, thank you. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] For $213.
[AGENT][NEUTRAL] OK, thank you. Alright, let me see if I can put that in.
[AGENT][NEUTRAL] And for future, you can check claim status online through our website at [PII] and that's just optional.
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Just make your claim. Let me pull this.
[AGENT][NEUTRAL] OK, and this is for code 99214.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, it looks like we received the claim [PII] process on [PII], and the claim was denied stating that office visits are not covered under the member's plan.
[CUSTOMER][NEUTRAL] Is this in general?
[AGENT][NEUTRAL] And when you say in general, you mean all.
[CUSTOMER][NEUTRAL] The what, what kind of coverage that?
[AGENT][NEUTRAL] This is a secondary.
[CUSTOMER][NEUTRAL] Like does she only have like emergency coverage or?
[AGENT][NEUTRAL] Mm, let me get her coverage because they're all different. We have many, many groups. Bear with me just a second.
[AGENT][NEUTRAL] All right. So this one in particular, um, this is not a guarantee of payment, just a verification of coverage. This one cover office procedures like if she has to do an X-ray, sonogram, um, injections, anything like that in the office, it will cover that co-payment or deductible, um, but it will not cover the co-payment for the visit itself. It does cover for like outpatient facilities, ER, uh, DME, cancer treatment, lab treatment, um.
[AGENT][MIXED] It does, it does have a lot of benefits, but the office visit itself is not covered.
[CUSTOMER][NEUTRAL] OK. Is there a way to get a copy of that EOB?
[AGENT][NEUTRAL] Um, yes, uh huh, what is the fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, that's [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Is it gonna be to your attention, Miss [PII]?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK. Do you mind holding for me while I send this out to you while I got you on the line before I let you go?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you. One moment.
[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. OK, Ms. Can, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, just the reference number please.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] You need the spelling of any other information? You're welcome, Miss [PII].
[CUSTOMER][POSITIVE] All right. Thank you so much.
[AGENT][NEUTRAL] I can see.