AccountId: 011433970860
ContactId: 2295580a-f929-4fe2-b500-ad5e37600098
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 358619 ms
Total Talk Time (AGENT): 84254 ms
Total Talk Time (CUSTOMER): 114309 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/2295580a-f929-4fe2-b500-ad5e37600098_20250606T17:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from provider's office, and this call will be recorded for quality and training purposes. Would you like to continue?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, so I was calling regarding a claim which was denied, so can you take a look on that?
[AGENT][POSITIVE] Yes [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And policy number for the patient?
[CUSTOMER][NEUTRAL] Uh, member ID is 206-59998.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Um, I don't have that, uh, patient on this policy. Did, did you say you have a claim number?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yes, the claim number is going to be.
[CUSTOMER][NEUTRAL] It is 3576549.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it looks like that's the.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] An old policy number. Let me pull up the right one. Hold on just a second.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] No, yeah, I, let me pull up the.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Claim number. I'm not seeing the it's under here.
[AGENT][NEUTRAL] 3576
[CUSTOMER][NEUTRAL] Uh, is that the
[CUSTOMER][NEUTRAL] Mhm, can you use this member ID 02515489.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK. And what was your question on the claim?
[CUSTOMER][NEUTRAL] Uh, actually I just want the correct denial reason on that.
[AGENT][NEUTRAL] Office visits are not covered under the policy.
[AGENT][NEUTRAL] And then,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And the rest of the uh denial was policy does not provide benefit for services in which no charges were incurred.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Under patient plan, right?
[AGENT][NEUTRAL] What, what was the question?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I'm telling that the office visits are not covered on that patient plan, right?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] OK, I have one more claim and for the same patient, can you take a look on that as well?
[AGENT][NEUTRAL] Uh, yes, give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] This
[AGENT][NEUTRAL] OK, what's the date of service or do you have the claim number?
[CUSTOMER][NEUTRAL] it
[CUSTOMER][NEUTRAL] Uh, date of service is [PII] for $649 even.
[AGENT][NEUTRAL] Uh, that was received on 325-25.
[AGENT][NEUTRAL] Process 3 27 25.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, we need a copy of the primary explanation of benefits.
[CUSTOMER][NEUTRAL] OK, uh, so where can I submit that mailing address fax number?
[AGENT][NEUTRAL] Fax number is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then our PO box is PO Box.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] You needed the PO box?
[CUSTOMER][NEUTRAL] Uh, can you provide me with the attention where I can send a fax?
[AGENT][NEUTRAL] That's our claims department fax number.
[CUSTOMER][NEUTRAL] OK. Uh, so any attention?
[AGENT][NEUTRAL] No, it just goes straight to our claims department so you don't have to put any attention.
[CUSTOMER][NEUTRAL] OK, OK, uh, repeating the fax number again, please check it is [PII], right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK, thank you so much, and [PII], do you have a call reference for this call?
[AGENT][NEUTRAL] For reference is my name, [PII], first initial to last name [PII], and today's date.
[CUSTOMER][POSITIVE] Thank you and have a great day thanks for the information.
[AGENT][POSITIVE] Thanks for calling APL. You too. Bye-bye.
[CUSTOMER][NEUTRAL] I