AccountId: 011433970860
ContactId: 1021eb6b-e374-4f7d-ad5c-a81897ce9820
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 192449 ms
Total Talk Time (AGENT): 78089 ms
Total Talk Time (CUSTOMER): 47829 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/1021eb6b-e374-4f7d-ad5c-a81897ce9820_20250220T21:01_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] Hey, [PII], I'm [PII] calling for products and to check on claim status.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status, [PII], and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 02548968.
[AGENT][NEUTRAL] Thank you and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Yeah, it's just the one claim.
[AGENT][NEUTRAL] All right, and can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the date of birth 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 and the total bills?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and total bill amount was $445 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the members first, I'm sorry, can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] But.
[AGENT][NEUTRAL] OK, this might be it. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 355.
[AGENT][NEUTRAL] 4050.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the policy provides no benefits for treatment of conditions other than defined by the policy.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Can you be more specific about the denial because the provider is confused about the denial.
[AGENT][NEUTRAL] It's not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK. It is not covered under the patient policy.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. May I have the call reference for this one?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name, which is [PII], first initial to my last name is [PII], and then today's date.
[CUSTOMER][POSITIVE] OK, [PII]. Thank you for providing me the information. Have a nice day.
[AGENT][POSITIVE] You're welcome, [PII]. You also, was there anything else I could assist with?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] All right, thanks for calling APL. Bye-bye.