AccountId: 011433970860
ContactId: 127c212c-8f30-4c5e-9c3c-a66e7ef4e471
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 197979 ms
Total Talk Time (AGENT): 86807 ms
Total Talk Time (CUSTOMER): 54330 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/127c212c-8f30-4c5e-9c3c-a66e7ef4e471_20250121T18:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from [PII]'s office regarding an old claim from [PII] that hasn't processed. I don't know if you never received it or what's going on with that.
[AGENT][NEUTRAL] OK, sure, [PII], I can assist you with claim status. Um, first, could I get a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] 944275, [PII].
[AGENT][NEUTRAL] Thank you. Now, please verify her date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And what's the date of service and bill charges on the claim?
[CUSTOMER][NEUTRAL] [PII], 24 $557.64.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] OK. Thanks for your patience. Um, yes, ma'am. We did receive that claim on [PII].
[AGENT][NEUTRAL] Um, it processed on [PII].
[AGENT][NEUTRAL] The claim number is 3513227 and it's denying because services provided in office is not covered under this policy.
[CUSTOMER][NEUTRAL] Services in office not covered?
[AGENT][POSITIVE] Yes, ma'am, that's correct.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Do you not cover physician offices? Is this like just a major medical type plan or?
[AGENT][NEUTRAL] But this is secondary gap insurance. What we do is cover the co-pay, the co-insurance, and the deductible after the primary insurance processes the claims, um, for coverage services. And I'm showing that under this policy, there's only coverage for, let's see, inpatient and outpatient hospitals and urgent care facilities. The doctor's office, yeah, there's no coverage.
[CUSTOMER][NEGATIVE] Zero coverage for doctor.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Can I have a call reference number?
[AGENT][NEUTRAL] Um, yes, but
[CUSTOMER][POSITIVE] Pretty pleasing thank you.
[AGENT][NEUTRAL] For the reference number, you can use my name and today's date. My name is [PII]. It's spelled [PII] and the last initial is [PII] and today's date. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] No ma'am, that's it you have a wonderful day thanks for your help.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL. Mm bye.
[CUSTOMER][NEUTRAL] Bye bye.