AccountId: 011433970860
ContactId: 0dc3e579-170b-47f9-8f3f-f2c1d6dafff7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 170550 ms
Total Talk Time (AGENT): 63910 ms
Total Talk Time (CUSTOMER): 69287 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/0dc3e579-170b-47f9-8f3f-f2c1d6dafff7_20250106T17:21_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh yes, I'm trying to see about a claim, please.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] My name is [PII]. My number is [PII].
[AGENT][NEUTRAL] [PII], thank you. Can I have the policy number of the member that you're inquiring eligibility for?
[CUSTOMER][NEUTRAL] 02466398
[AGENT][NEUTRAL] Give me the policy number one more time.
[CUSTOMER][NEUTRAL] 02466398
[AGENT][NEUTRAL] Could you verify that patient's name and date of birth that you're inquiring claim status for?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] The date of birth?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what is the date of service you're calling us to check the status of a claim for?
[CUSTOMER][NEUTRAL] Um, my, my mom.
[CUSTOMER][NEUTRAL] I um do do do.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] There was no payment made on this claim and the reason why is because the services provided are not covered under the policy.
[CUSTOMER][NEGATIVE] OK, so that service is not even covered.
[AGENT][NEUTRAL] No, this policy only covers preventative and basic services.
[CUSTOMER][NEUTRAL] OK, let's see Cas preventative and basic.
[CUSTOMER][POSITIVE] Uh, I'm pro I it.
[AGENT][NEUTRAL] Would you like the claim number?
[CUSTOMER][NEUTRAL] Nah.
[CUSTOMER][NEUTRAL] Well, because someone wrote a letter in here or a note saying call to see what needs to be get done to get this pay. They are needing to have eligibility letter sent to the APL claims.
[AGENT][NEUTRAL] Mm, no, the policy doesn't cover major services. I'm not sure if someone called to verify their benefits prior to the services, but it's definitely not covered. It's only preventative and basic services covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And [PII] is a.
[CUSTOMER][NEUTRAL] Um, major
[AGENT][NEUTRAL] Considered as major period which is not covered under the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Considered.
[CUSTOMER][NEUTRAL] Ma. OK. Do you have a reference number?
[AGENT][NEUTRAL] We don't provide those, [PII], but you can use my name in today's date as a reference.
[CUSTOMER][NEUTRAL] And your name again? I'm sorry.
[AGENT][NEUTRAL] It's [PII] and today's date.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a good day. Goodbye.
[CUSTOMER][NEUTRAL] You too. Bye bye.