AccountId: 011433970860
ContactId: 17af5c96-54eb-4982-8e1f-6f18388e48ea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 293119 ms
Total Talk Time (AGENT): 122143 ms
Total Talk Time (CUSTOMER): 60251 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/17af5c96-54eb-4982-8e1f-6f18388e48ea_20250210T19:24_UTC.wav
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[AGENT][NEUTRAL] Afternoon, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I'm calling to check on claim status.
[AGENT][NEUTRAL] OK, [PII], you're needing to check claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII], thank you. And how many claims do you have to check status on today?
[CUSTOMER][NEUTRAL] Just one.
[AGENT][NEUTRAL] OK, and what is that member's policy number, please?
[CUSTOMER][NEUTRAL] 21361.
[AGENT][NEUTRAL] OK, that's a group number. There should be, there's another number on the front of the ID card.
[CUSTOMER][NEUTRAL] Let me look at the card, sorry.
[AGENT][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] And depending on what type of policy they have with us, uh, [PII]'s how it would be worded. You may see an in-hospital or an outpatient number, policy certificate, policy search.
[CUSTOMER][NEUTRAL] 01
[CUSTOMER][NEUTRAL] I have something here it's 01678802.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] M as in Mary L 8.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And any information [PII] that I do provide will be a verification of benefits and not a guarantee of payment. What is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her place?
[CUSTOMER][NEUTRAL] Uh there sorry.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII] $294.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. So I see that this claim was received. The received date was [PII].
[AGENT][NEUTRAL] It was processed the same date.
[AGENT][NEUTRAL] The claim number is 3546931.
[AGENT][NEGATIVE] And this claim was denied.
[AGENT][NEUTRAL] And the reason for the denial?
[AGENT][NEUTRAL] I office visits are not covered by the above numbered policy?
[AGENT][NEGATIVE] And the other denial remark is this service is not covered when performed in a doctor's office or clinic.
[AGENT][NEUTRAL] Now I don't know if you already have our website or not, but [PII], we do have a portal in which you can print the EO the COB rather if you need one, a copy of it.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that portal website that you would go to now that you have the claim number is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Very good, um, is there a reference number or is it just your name?
[AGENT][NEUTRAL] That would be my name along with today's date and [PII] is [PII]
[CUSTOMER][POSITIVE] Thank you [PII] have a great day.
[AGENT][POSITIVE] Well, I hope you do too, [PII] that's all I can help you with, and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Alright bye bye