AccountId: 011433970860
ContactId: 1e7d690b-24b7-40f3-8c9a-23cfec4203f8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 297839 ms
Total Talk Time (AGENT): 84823 ms
Total Talk Time (CUSTOMER): 178432 ms
Interruptions: 3
Overall Sentiment: AGENT=1.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/1e7d690b-24b7-40f3-8c9a-23cfec4203f8_20250408T19:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling AP. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. This is [PII] calling from provider's office to check up on a claim status.
[AGENT][NEUTRAL] What is your call back number?
[CUSTOMER][NEUTRAL] Uh, our callback number is [PII].
[AGENT][NEUTRAL] What is your policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Yeah, sure. I will confirm you. Just allow me a moment. And uh your name is [PII], right?
[AGENT][POSITIVE] That is correct, [PII].
[CUSTOMER][NEUTRAL] OK, OK. All right. And you want, uh, you mean to say that the member's ID, right?
[AGENT][NEUTRAL] I'm asking for the policy number.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Policy number. Just hold a moment. I will check.
[CUSTOMER][NEUTRAL] I all day.
[CUSTOMER][NEUTRAL] The policy number is 02150688.
[AGENT][NEUTRAL] OK, let me just repeat that 02156688.
[CUSTOMER][NEUTRAL] Uh, sorry, you have missed 0. It's 02150688.
[AGENT][NEUTRAL] Thank you. Verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, sure. The patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for that information, [PII]. You're calling for claim statuss member. I can assist you with is that date of service and the total charge amount please.
[CUSTOMER][NEUTRAL] Yeah, sure. Uh, the date of service is [PII] and the bill amount is $222.
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] I got
[AGENT][NEUTRAL] And also tell me you're able to check claim status and obtain an EOB on our website at [PII]. That shows that we did receive the claim. The claim was received and it denied as office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] But it was a little bit.
[CUSTOMER][NEUTRAL] Uh, just hold a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The claim is denied the uh because the policy doesn't cover what, uh, exactly what is not covered uh in the patient policy.
[AGENT][NEUTRAL] OK, office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] I go.
[CUSTOMER][NEUTRAL] Office visits.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And I
[CUSTOMER][NEUTRAL] Office visit is not covered in patient plan, right?
[AGENT][NEUTRAL] Offices is not covered by the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, just wait a moment, just hold on.
[CUSTOMER][NEUTRAL] OK sure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, but in the previous year, we have mentioned that the service is not provided by the, uh, by network PCP. So could you just please confirm me the, like, uh, it is related to the primary care physician or like uh it is related to the office visit?
[AGENT][NEUTRAL] Per the policy that the member has with APL, it does not cover office visits.
[CUSTOMER][NEUTRAL] All right. OK, OK. And can you please just confirm me like on which detail you have received the click?
[AGENT][NEUTRAL] Of course, the claim was received on [PII] and processed and denied on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]. All right.
[CUSTOMER][NEUTRAL] And do I have the claim number for this?
[AGENT][NEUTRAL] Of course I can provide it to you. That is 3506318.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can I have the call reference number for this?
[AGENT][NEUTRAL] If we do not provide call reference numbers, [PII]. You can use my name [PII], and today's date. Anything else I can help you with?
[CUSTOMER][NEUTRAL] with that
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Uh, OK. Your name is [PII] and last name initial is [PII], and today's date, right?
[AGENT][POSITIVE] That is correct, [PII].
[CUSTOMER][POSITIVE] All right, thank you so much, [PII]. yeah.
[AGENT][POSITIVE] You're welcome and thank you very much for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Um, you too bye bye.
[AGENT][NEUTRAL] Bye bye.