AccountId: 011433970860
ContactId: 0dcd0a8a-505a-496c-95e3-7851b339fa0a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 604409 ms
Total Talk Time (AGENT): 177335 ms
Total Talk Time (CUSTOMER): 304387 ms
Interruptions: 5
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/0dcd0a8a-505a-496c-95e3-7851b339fa0a_20250515T19:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], this from the provider's office. Could you please spell your name?
[AGENT][NEUTRAL] It's [PII], and I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, uh, can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yes, it's [PII] and the extension number is [PII].
[AGENT][POSITIVE] Thank you and uh what can we help you with today?
[CUSTOMER][NEUTRAL] Yes, uh, today I have a claim, so please, uh, let me know the claim status for this one.
[AGENT][NEUTRAL] Yeah, I could check on a claim for you. Do you have that policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 01792115.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] I was [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. And uh what was the date of service for this claim, please?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Uh yeah.
[CUSTOMER][NEUTRAL] Um, could you please, uh, yes, hello?
[AGENT][NEUTRAL] Yes, uh, do you have the date of service for this claim?
[CUSTOMER][NEUTRAL] Do you have this, ma'am?
[CUSTOMER][NEUTRAL] Yes. The date of service is uh [PII].
[CUSTOMER][NEUTRAL] Sorry, for this one, date of services is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what was that billed amount, please?
[CUSTOMER][NEUTRAL] Yes, bill amount would be, give me a moment, pulling out the information. It's $115. 85 cents.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, that was $115.85.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK thank you one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] What was the name of this uh provider [PII]?
[CUSTOMER][NEUTRAL] It's sleep remedies.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Me
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, one moment please.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] When will you receive this claim?
[AGENT][NEUTRAL] Uh, give me just a moment. I'm making sure that I did find the correct claim.
[CUSTOMER][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] OK, yes, so I did find this claim. It looks like we paid a benefit of $90.34. Did you need that claim number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] That is 35.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 87
[AGENT][NEUTRAL] 468.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, this claim was received [PII].
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it did process on [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, did you need the check number?
[CUSTOMER][NEUTRAL] Yes. Uh, no, I have an issue with this, uh, item. Uh, we got the denial for this 7038. Could you please tell me what's the reason of this one?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, one moment.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so that particular item did not meet the policy's definition of durable medical equipment, so we were unable to pay a benefit. It was not a covered DME.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] uh, like the insurance don't cover the item?
[AGENT][NEGATIVE] This policy does not correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. So what is the call reference for this one?
[AGENT][NEUTRAL] That would be my first name, last initial, and today's date, uh, so my last initial is [PII]
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] Uh, [PII], yes, uh [PII], and was there anything else I could help you with?
[CUSTOMER][NEUTRAL] And to.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] Yes, I have one more clip in my file. So whenever you are ready, let me know. I, uh, yeah, it's for the sleep remedies. Uh, no, it's for the different member and the member ID would be 2,566,560. And uh the date of service for this one is [PII].
[AGENT][NEUTRAL] Is is this for the same member?
[AGENT][NEUTRAL] It is for the same member?
[CUSTOMER][NEUTRAL] And the member name is [PII].
[AGENT][NEUTRAL] Do you have the member's date of birth?
[CUSTOMER][NEUTRAL] Yes, it's uh [PII].
[AGENT][NEUTRAL] OK, and what was the bill amount for this claim, please?
[CUSTOMER][NEUTRAL] Yes. The bill amount is
[CUSTOMER][NEUTRAL] Give me a moment. It's 462 dollars.1 cents.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][POSITIVE] OK, take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] That.
[AGENT][NEUTRAL] With this claim from the same provider, uh, sleep remedies?
[CUSTOMER][NEUTRAL] Yeah, it's for the sleep remedies.
[AGENT][NEUTRAL] OK, so I did find this claim we did pay a benefit of $378.81. Um, what information did you need?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Claim number, what's the claim number for this one?
[AGENT][NEUTRAL] That is 358-7312.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was uh received [PII] and was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, as here, the, we got the desire for 87038.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me see, I believe that's going to be the same denial reason. Yes, the denial reason is the same as the other. It's not, uh, it's not a covered, uh, DME.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] Could you please provide me the reference for this one? What's the reference number?
[AGENT][NEUTRAL] Uh, reference is the same, uh, so it'd be my first name, last initial, and today's date.
[CUSTOMER][NEUTRAL] OK. I have one more claim for the next member that I have on the file is, uh, and the member ID is C as in Charlie, A as in Papa, 6 6208526, and the member name is.
[AGENT][NEUTRAL] OK, that is not one of our, excuse me, I'm so sorry, that's not one of our policy numbers. Our policy numbers do not begin with letters.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right. OK. Thank you. Thank you for your time. I can see if I have one more. Mhm. Give me a moment.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So, OK. Uh, yeah.
[CUSTOMER][NEUTRAL] Give me a moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] If this number is with you, the member ID is A as in
[CUSTOMER][NEUTRAL] Uh, Alpha, M as in Mike, H as in Henry, 6216947.
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] No, our policy numbers do not begin with letters.
[CUSTOMER][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] OK. It started with the numeric word, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you, thank you for your time. Like, uh, it's, uh, uh, I only have 2 members in the file. Thank you. Thanks for your time. Bye for now. Take care.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] You're welcome. Have a great rest of your day. Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Ma'am.