AccountId: 011433970860
ContactId: 1f9a17e1-6352-4560-9029-df8702294124
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 899190 ms
Total Talk Time (AGENT): 278243 ms
Total Talk Time (CUSTOMER): 307966 ms
Interruptions: 10
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/1f9a17e1-6352-4560-9029-df8702294124_20250617T18:50_UTC.wav
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[AGENT][POSITIVE] Thanks for calling.
[CUSTOMER][NEUTRAL] Is this a medical uh provided plan?
[AGENT][NEUTRAL] Are you, what are you trying, what do you need help with?
[CUSTOMER][NEUTRAL] Uh, I need your help regarding claim status for members.
[AGENT][NEUTRAL] Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] Uh yes, it's [PII] Last name is, my name is [PII]. And last name is, my name is
[CUSTOMER][POSITIVE] [PII], yes.
[AGENT][NEUTRAL] And what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And you're calling to verify?
[AGENT][NEUTRAL] Claim status, correct.
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] What is the policy number that you're calling to check the status of a claim for?
[CUSTOMER][NEUTRAL] I have 4 members. The first policy number is
[CUSTOMER][NEUTRAL] 20
[CUSTOMER][NEUTRAL] Sorry, 0245
[CUSTOMER][NEUTRAL] 2336 M as in Mary.
[AGENT][NEUTRAL] Could you repeat the beginning of the number again? I don't mean to cut you off.
[CUSTOMER][NEUTRAL] 02452336. M as in Mary, L as in Lima, 8 numerical.
[AGENT][NEUTRAL] 2452336, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm not pulling up a policy. Could you verify if that policy is correct?
[AGENT][POSITIVE] The policy number is correct.
[CUSTOMER][NEUTRAL] It's ML8.
[CUSTOMER][NEUTRAL] After 36 is M as in Mary, L as in Lima, and then 8, numerical 8.
[AGENT][NEUTRAL] Right, so what are the numbers without the zeros?
[CUSTOMER][NEUTRAL] 02452336
[CUSTOMER][NEUTRAL] Mary Lima 8. That is the policy number.
[AGENT][NEUTRAL] So you gave me 2452336. It's not pulling up a policy.
[CUSTOMER][NEUTRAL] But after that, Mary Lima 8, that is also.
[AGENT][NEUTRAL] Right, we don't need that. We don't, I don't need that information to pull up the policy. I just need, need the numeric part of the policy after the zeros.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Not pulling up a policy. What's your next policy number?
[CUSTOMER][NEUTRAL] Just give me a moment, let me uh recheck.
[CUSTOMER][NEUTRAL] It's 01923350.
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I know.
[AGENT][NEUTRAL] OK, so give me that policy number one more time.
[CUSTOMER][NEUTRAL] 01923350.
[AGENT][NEUTRAL] What is the member's name and date of birth?
[CUSTOMER][NEUTRAL] My first name is [PII]. Last name is [PII]
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're calling to check the status of a claim for what date of service?
[AGENT][NEUTRAL] Hello, caller, are you there?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] I didn't hear anything if you said anything after I asked you the question of the date of service for the claim status.
[CUSTOMER][NEUTRAL] Uh yes, it's for [PII] with the amount of.
[CUSTOMER][NEUTRAL] 3 $535.80.
[AGENT][NEUTRAL] And do you have a procedure code?
[CUSTOMER][NEUTRAL] Uh, yes, I have one postal code [PII].
[CUSTOMER][NEUTRAL] Sorry, 38. It got
[AGENT][NEUTRAL] 87035.
[AGENT][NEUTRAL] So what is the procedure called?
[CUSTOMER][NEUTRAL] Sorry, 38.
[CUSTOMER][NEUTRAL] 87038.
[AGENT][NEUTRAL] I'm not showing a claim on file for [PII] with that procedure code.
[CUSTOMER][NEUTRAL] No claim on file with this process code?
[AGENT][NEUTRAL] Yes, no claim on file for [PII] with procedure code of 87038.
[AGENT][NEUTRAL] Are you sure that's the correct procedure code?
[CUSTOMER][NEUTRAL] Uh yes, 87038.
[AGENT][NEUTRAL] There's no claim on file for 87038.
[CUSTOMER][NEUTRAL] Can I have the call reference for uh this number?
[AGENT][NEUTRAL] We don't provide reference numbers. You can use my name in today's date as a reference. It's S [PII].
[CUSTOMER][NEUTRAL] Can you please provide me your name?
[CUSTOMER][NEUTRAL] Can you please repeat it once again for me?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. One last policy ID.
[AGENT][NEUTRAL] Give me one moment please.
[AGENT][NEUTRAL] I have to make notes on the the policy that I'm currently in.
[CUSTOMER][NEUTRAL] Just let me know once you're ready for the next number ID.
[AGENT][NEUTRAL] And what was the amount of that claim?
[CUSTOMER][NEUTRAL] I have not provided you the uh policy number.
[AGENT][NEUTRAL] The amount of the claim that you were calling to check the status of the claim of the policy that we just was talking about.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, uh, where you stated that there is no claim on file?
[AGENT][POSITIVE] Right, yes, that's correct.
[CUSTOMER][NEUTRAL] Uh yes, the bill amount is uh
[CUSTOMER][NEUTRAL] $535.80.
[CUSTOMER][NEUTRAL] On my physics
[AGENT][NEUTRAL] What is the next policy number?
[CUSTOMER][NEUTRAL] OK. The next policy number is 60801.
[AGENT][NEUTRAL] That's not a policy number. That's uh, that is the number to submit electronic claims.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Can you please uh search the member by member's name?
[AGENT][NEUTRAL] Do you have a social?
[CUSTOMER][NEUTRAL] We don't have the access to member's social security number.
[AGENT][NEUTRAL] Spell the member's last name.
[CUSTOMER][NEUTRAL] Last name is spelled as [PII].
[AGENT][NEUTRAL] First name?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What city and state does [PII] live in?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What city and state does [PII] live in?
[CUSTOMER][NEUTRAL] Uh, uh, state is [PII].
[AGENT][NEUTRAL] And what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. What is the date of service that you're calling to check the status of a claim for [PII]?
[AGENT][NEUTRAL] If you're saying something, I can't hear you.
[CUSTOMER][NEUTRAL] Yes, please. I'm extremely sorry. Um, my voice is just disturbing, um, system is going a bit slow. Yes, please.
[CUSTOMER][NEUTRAL] It is uh living in [PII].
[AGENT][NEUTRAL] What is the date service of the claim that you're calling to check the status of?
[CUSTOMER][NEUTRAL] Winter Spring, Florida.
[CUSTOMER][NEUTRAL] Uh, [PII] with the amount of.
[CUSTOMER][NEUTRAL] $94.95.
[AGENT][POSITIVE] Thank you. 0327.
[AGENT][NEUTRAL] 327.
[AGENT][NEGATIVE] This claim was received [PII]. It was processed [PII]. There was no payment made on this claim, and the reason why there was no payment made on this claim because doable medical equipment is not covered under the policy. The policy does not provide benefits for durable medical equipment.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And the patient policy?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][POSITIVE] OK. Thank you so much uh for your precious time information. I really appreciate it. Have a wonderful day.
[AGENT][NEUTRAL] And could you give me, could you go back to the very first claim policy number that you provided me and
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][POSITIVE] Oh yes. If you can assist me on that, uh, that would be so helpful of yours.
[AGENT][NEUTRAL] Mhm. What is the policy number?
[CUSTOMER][NEUTRAL] Uh, just give me a moment, please.
[CUSTOMER][NEUTRAL] Uh yes. Uh, the policy number is 90, 02452336.
[AGENT][NEUTRAL] And what is that member's name?
[CUSTOMER][NEUTRAL] Ma'am, first name is spelled as in [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Hey
[AGENT][NEUTRAL] First name and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh last name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service that you're calling to check the status of a claim for?
[CUSTOMER][NEUTRAL] I have two dates of service for uh this member. First one is for December.
[AGENT][NEUTRAL] I can only look at one at a time. What is the first one?
[CUSTOMER][NEUTRAL] [PII] with the amount of $484.02.
[AGENT][NEUTRAL] [PII]. What is your procedure code?
[CUSTOMER][NEUTRAL] 87038.
[CUSTOMER][NEUTRAL] Denied as covered by other payers.
[AGENT][NEUTRAL] For [PII], the claim is for [PII] for [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And did you say A as in alpha or 8?
[CUSTOMER][NEUTRAL] A as in Alpha, 7038.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] 5717.
[AGENT][NEUTRAL] This claim was received [PII]. It was processed [PII]. There was a payment of $402.96 paid on this claim.
[CUSTOMER][NEUTRAL] Why it is not paid for 87038?
[AGENT][NEUTRAL] Because it's not, we don't cover disposable benefits.
[AGENT][NEGATIVE] We don't provide benefits for disposable items.
[CUSTOMER][NEUTRAL] OK. Um, can you please
[CUSTOMER][NEUTRAL] For this first call?
[AGENT][NEUTRAL] Yes, that is correct. It's considered as disposable and the policy does not cover disposable.
[CUSTOMER][NEUTRAL] Uh, can, can you please uh provide me the received date and denied date once again, a bit slower?
[AGENT][NEUTRAL] Items.
[AGENT][NEUTRAL] Sure, give me one moment.
[AGENT][NEUTRAL] The claim was received [PII]. It was processed [PII].
[CUSTOMER][NEUTRAL] OK, not covered?
[CUSTOMER][NEUTRAL] By the insurance?
[AGENT][NEUTRAL] Yes, that is correct. It's not covered because the policy does not cover disposable items.
[CUSTOMER][NEUTRAL] Disposal
[AGENT][NEUTRAL] What is your next date of service?
[CUSTOMER][NEUTRAL] Item. OK.
[CUSTOMER][NEUTRAL] And the last date of service is uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What is your procedure code?
[CUSTOMER][NEUTRAL] Same procedure code 87038.
[AGENT][NEUTRAL] 756 2.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This claim was received [PII]. It was processed [PII].
[AGENT][NEUTRAL] [PII], there was no payment on that procedure code because disposable is not covered under the policy.
[CUSTOMER][POSITIVE] OK. Uh, thank you so much for your help. Can you please spell out your name once again for me?
[AGENT][NEUTRAL] [PII], and today's date as a reference. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Because I need a call reference.
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][POSITIVE] Uh no, thank you so much. Have a wonderful day.
[AGENT][POSITIVE] Thanks for calling APL [PII]. You have a great one as well. Bye bye.