AccountId: 011433970860
ContactId: 1745fefc-27fc-4a7c-a1fb-2a82732b8fd7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 192860 ms
Total Talk Time (AGENT): 70370 ms
Total Talk Time (CUSTOMER): 78942 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/1745fefc-27fc-4a7c-a1fb-2a82732b8fd7_20250508T22:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I'm calling for a provider to check on additional information about a claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes. Could you please spell out your name?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sir,
[AGENT][POSITIVE] Yes, it's [PII] and I can definitely look at that claim for you. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, correct. It's [PII] my last name is [PII]. And how are you doing today?
[AGENT][NEUTRAL] Got it.
[AGENT][POSITIVE] I'm doing all right how about you?
[CUSTOMER][POSITIVE] That way that I'm doing good as well. Thank you for asking.
[AGENT][POSITIVE] Glad to hear it. Uh, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[CUSTOMER][NEUTRAL] [PII] and it is a direct line.
[AGENT][NEUTRAL] Thank you. And do you have that policy number?
[CUSTOMER][NEUTRAL] Sorry, it is 02585456.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, the patient's name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Head of service is [PII].
[AGENT][NEUTRAL] [PII] and then do you have that billed amount?
[CUSTOMER][NEUTRAL] Yes, it is 100, sorry.
[CUSTOMER][NEUTRAL] It is $225.47.
[AGENT][POSITIVE] OK, got it, thank you one moment please.
[CUSTOMER][NEUTRAL] So, can I take your time?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so we did receive this claim to, uh, we were unable to pay a benefit as durable medical equipment is not covered under this policy.
[CUSTOMER][NEUTRAL] So it is not covered under the patient's policy or the provider's contract or the payer guidelines.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Uh, under the patient's policy, it's not covered.
[CUSTOMER][NEUTRAL] Hi,
[CUSTOMER][NEUTRAL] Thank you for that. May I know the patient's plant type?
[AGENT][NEUTRAL] Oh, yes, this is a secondary medical policy.
[CUSTOMER][NEUTRAL] Is there any
[CUSTOMER][NEUTRAL] Thank you for that. May I have the call reference number of our call for today?
[AGENT][NEUTRAL] Sure, reference number would just be my first name, last initial, and today's date. Uh, so my last initial is [PII], uh, did you need this claim number or anything, [PII]?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Could you please verify the claim number? Is it 359-0460. Is that correct?
[AGENT][POSITIVE] That's correct, yes.
[AGENT][NEUTRAL] Alrighty, was there anything else I could help you with?
[CUSTOMER][POSITIVE] Thank you for your.
[CUSTOMER][POSITIVE] No, [PII], that is for today. You have till today. Have a great day. Bye for now.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] Yeah, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] I.