AccountId: 011433970860
ContactId: 22f93577-7c15-4fa9-9446-e6168567a0b3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 225429 ms
Total Talk Time (AGENT): 102929 ms
Total Talk Time (CUSTOMER): 79897 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/22f93577-7c15-4fa9-9446-e6168567a0b3_20250116T13:57_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. With whom am I speaking? How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from a provider's office to check on a denied claim status.
[AGENT][POSITIVE] OK, and a good call back number for you, [PII], in case we get disconnected?
[CUSTOMER][NEUTRAL] Mhm. Of course, it's gonna be that [PII] and that's gonna be the best direct line to reach me out.
[AGENT][NEUTRAL] OK, and what's the policy number you're calling regarding?
[CUSTOMER][NEUTRAL] Mhm. Yeah, I have the member ID. It's gonna be 679178263.
[AGENT][NEUTRAL] Did you say 679178-263?
[CUSTOMER][POSITIVE] Yes, that's quite great.
[AGENT][NEUTRAL] OK, um,
[AGENT][NEUTRAL] OK, so, uh, verification of coverage does not guarantee the payment of a claim. I can assist you today with the denial status. Unfortunately, the ID number, policy number you gave me is not a policy number I can find in our system. Do you happen to have the member's social security number?
[CUSTOMER][NEUTRAL] Well, let me check for the social number.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh, I apologize for that. I don't have a patient's social security number. Can you please start with the patient's name?
[AGENT][NEUTRAL] OK, so let me try, let me try to look by the name. Let me, give me one moment. Let me try by the name if you would allow me to just speak and try to assist you. Thank you.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, spell the last name?
[CUSTOMER][NEUTRAL] Yeah, it's spelled [PII].
[AGENT][NEUTRAL] OK, [PII], and what's the first name?
[CUSTOMER][NEUTRAL] You spell [PII].
[AGENT][POSITIVE] Thank you for that information. Now let's see here.
[AGENT][NEUTRAL] And is this, uh, this, you're checking the status on a medical claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Or
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] For a medical claim?
[CUSTOMER][NEUTRAL] Also, I do have a claim number. If you need, I'll let you know that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, first I have to have a policy number. We can't just search by claim number unfortunately.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEGATIVE] Um, and unfortunately, I do not see that this member has.
[AGENT][NEUTRAL] Um, maybe you're calling regarding the accident policy. Let me check and see.
[AGENT][NEUTRAL] Verify the member's date of birth.
[AGENT][NEUTRAL] Verify the member's date of birth please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yup, yup, the patient's date of birth is [PII].
[AGENT][NEUTRAL] OK, so no, that's not it.
[AGENT][NEUTRAL] OK, we don't have a patient on file, well not a patient, an insured on file that matches that date of birth. So unfortunately you would need to reach out to the member to get the correct policy number if they have a policy with us, OK? Anything else I can help you with today, [PII]?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] [PII], I have no more questions. Uh, you said that the member was not fine, right?
[AGENT][NEUTRAL] Yeah, not found. That's right. OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Let, let me check with the information from the patient. Thank you, [PII]. Have a great day. Take care. Bye-bye.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] You too. Take care. [PII]. Thanks for calling APL [PII]. Bye bye.
[CUSTOMER][NEUTRAL] Mhm