AccountId: 011433970860
ContactId: 0d59728c-a57c-475a-8cd1-ba1cefe439ce
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 351970 ms
Total Talk Time (AGENT): 127460 ms
Total Talk Time (CUSTOMER): 127588 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/0d59728c-a57c-475a-8cd1-ba1cefe439ce_20250124T15:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hey, good morning. My name is [PII]. I'm calling from provider's office. I need to check on the claim status. Will you please help me with that?
[AGENT][POSITIVE] I can help you spell your first name for me.
[CUSTOMER][NEUTRAL] Yeah, it is [PII]. So it's spelled as [PII] and my last name initial is [PII].
[AGENT][NEUTRAL] And so it's pronounced.
[CUSTOMER][NEUTRAL] And you said your name is?
[AGENT][NEUTRAL] It's pronounced [PII].
[CUSTOMER][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] My name is [PII] First initial of my last name is [PII] If you can provide the policy number and a good phone number in case we're disconnected, please.
[CUSTOMER][NEUTRAL] Yeah, the callback number that is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Direct line?
[AGENT][NEUTRAL] And the policy number?
[CUSTOMER][NEUTRAL] Uh, yeah, the member policy number that is uh 01930691 M as in Mike L as in Lima 7.
[AGENT][NEUTRAL] Thank you, can you verify the patient's name and date of birth for me please?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth, that is uh [PII].
[AGENT][NEUTRAL] Thank you and you said that you're checking claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, I'll need the date of service in charge, and I can I help you?
[CUSTOMER][NEUTRAL] For the date of service
[CUSTOMER][NEUTRAL] Yeah, it is [PII]. Yeah, it is [PII]. Charge amount is $307 even.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 307 even. Yeah.
[AGENT][NEUTRAL] So this claim was received [PII].
[AGENT][NEUTRAL] Process [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, there was no payment made. The office visit fee is not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Uh, so the claim has been denied?
[AGENT][NEUTRAL] No payment was made, so yes, because the office visit is not covered by the patient's policy.
[CUSTOMER][NEGATIVE] Oh not covered.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the the patient's policy, right? What is the patient's, uh, policy, what is the member's planning?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] It's a Metlink policy.
[CUSTOMER][NEUTRAL] Sorry, repeat that again, please?
[AGENT][NEUTRAL] Medin policy.
[CUSTOMER][NEUTRAL] Meddling policy, right?
[CUSTOMER][NEUTRAL] OK, so this is in patient responsibility, right?
[AGENT][NEUTRAL] We do not determine patients responsibility. We can just provide the status of the claim according to their policy benefits.
[CUSTOMER][NEUTRAL] OK, allow me a minute.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So you said the office visits are not covered under the member's policy, right?
[CUSTOMER][NEUTRAL] Uh, no problem. What is the claim number? Can I know that?
[AGENT][NEUTRAL] 355.
[AGENT][NEUTRAL] 2978.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And a cost you can also check status on our online service center at [PII]. And did you have any other questions?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is it possible for you to fax that explanation benefits to us, please?
[AGENT][NEUTRAL] Um, it was actually just recently mailed, so you should be receiving it shortly or you can download it from the online service center. I can assist you with creating that account if you would like.
[AGENT][NEUTRAL] So it was processed on the [PII]. The explanation was mailed out the next business day.
[CUSTOMER][NEUTRAL] We need to get the
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] It's probably en route.
[CUSTOMER][POSITIVE] Pro with the web portal, yeah, provide me the website uh name for you.
[AGENT][POSITIVE] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] [PII], right? [PII], OK.
[CUSTOMER][NEUTRAL] OK, that is the website, right? No problem.
[AGENT][NEUTRAL] Mhm. Do you wanna go ahead and create it? I can assist you with doing that.
[CUSTOMER][NEUTRAL] What is the conference number for our conversation?
[CUSTOMER][NEUTRAL] Right, that's [PII], right? That is the correct mailing address?
[AGENT][NEUTRAL] It's the web address.
[CUSTOMER][NEUTRAL] Yeah, that is the correct website, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] Oh, it does not
[CUSTOMER][NEUTRAL] It is secured or it is secure?
[AGENT][NEUTRAL] [PII] on [PII].
[CUSTOMER][NEUTRAL] [PII], right. OK, once again.
[CUSTOMER][NEUTRAL] Still, it does not, uh,
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], right? That's not getting loaded.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEGATIVE] It is showing the site can't be reached.
[AGENT][NEUTRAL] OK. Remove the [PII].
[CUSTOMER][NEUTRAL] OK, one second. Yeah, that's, that is it just when you log in now.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Are you on the home page online service center welcome?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So you would click the new user tab to the right.
[CUSTOMER][NEUTRAL] Mhm. Got it. Pro is the caller reference number for our conversation, [PII]?
[AGENT][NEUTRAL] You'll use my name in today's date as your reference.
[AGENT][NEUTRAL] And did you want me to stay on the line while you complete the account?
[CUSTOMER][POSITIVE] Uh, no, thank you so much.
[AGENT][NEUTRAL] All right. Anything else?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] Alrighty thanks for calling APL have a good day.
[CUSTOMER][NEUTRAL] You too.