AccountId: 011433970860
ContactId: 20690ed8-e295-44df-b307-9548d9abbc45
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 300850 ms
Total Talk Time (AGENT): 108852 ms
Total Talk Time (CUSTOMER): 75030 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/20690ed8-e295-44df-b307-9548d9abbc45_20250218T16:06_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Very good morning. My name is [PII] calling you from provider's office, checking on general claim status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII] it's a direct line.
[AGENT][NEUTRAL] Thank you and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 02460355
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] the patient, first name is [PII] and the last name is [PII] Date of birth is [PII].
[AGENT][NEUTRAL] What was the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII]. Total charge $643 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm for future you can check claim status online through our website at [PII] and that's just optional. And let's see, so it looks like we processed this claim. Um, let me check that.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK, it looks like we received a claim [PII] and processed [PII]. The claim was denied stating that office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Are not covered by the policy. OK. Can I get the claim number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure. 353-9855.
[CUSTOMER][NEUTRAL] Just to confirm, it is 353-9855. Am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. Can you check for the last number?
[AGENT][NEUTRAL] Bear with me, I need to make a note before I move forward to another policy.
[AGENT][NEUTRAL] You want the next policy number?
[CUSTOMER][NEUTRAL] 02473162
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh yeah, the patient's first name is [PII] and the last name is [PII] Date of birth is [PII].
[AGENT][NEUTRAL] OK, what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The date of service is [PII]. Total charge $355 even.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] One moment, let me pull the EOB.
[AGENT][NEUTRAL] OK, so it looks like we received the claim [PII], processed [PII].
[AGENT][NEUTRAL] And the claim was denied, and the reason for this denial is that um benefits are payable on the certificate are limited to those obtained in the scheduled benefits. This is not a covered loss under the plan.
[CUSTOMER][NEUTRAL] It's not covered under patient plan, I'm right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, can I get the claim number?
[AGENT][NEUTRAL] Sure, that is 354-027-1.
[CUSTOMER][NEUTRAL] Just to confirm, it is 354-027-1. I'm right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. And may I have your name spelled, please?
[AGENT][NEUTRAL] My name is [PII]. That's [PII]. That's initial [PII]. Is there anything else I may help you with today, Mr. [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, uh, no, it was great speaking with you. Have a good day. Bye bye.
[AGENT][POSITIVE] You as well thank you for calling APL. Bye bye.