AccountId: 011433970860
ContactId: 2539bb13-a7ec-447e-906a-f8d94413de76
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 351899 ms
Total Talk Time (AGENT): 139790 ms
Total Talk Time (CUSTOMER): 113069 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/2539bb13-a7ec-447e-906a-f8d94413de76_20250527T20:49_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. This is [PII] calling from the provider's office to check on the claim status. And if you don't mind, could you spell your name for me?
[AGENT][NEUTRAL] Yes, my name is [PII]
[AGENT][NEUTRAL] The first initial
[CUSTOMER][POSITIVE] Thank you for that.
[CUSTOMER][NEUTRAL] Yes, go ahead.
[AGENT][NEUTRAL] The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you for the time ma'am.
[AGENT][NEUTRAL] You're welcome. And can you spell your first name for me, please, and provide a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, no problem. It is [PII]. Callback number is [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It is 113-0252 M as in Mike, L as in Lima, 5.
[AGENT][NEUTRAL] OK, and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Only one.
[AGENT][NEUTRAL] OK, can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the member's name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] Yes, it is [PII] for the total bill amount of $643 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK. And um
[CUSTOMER][NEUTRAL] For the amount of $643.
[AGENT][NEUTRAL] Thank you. The reason I'm asking is because I don't see a claim here on file for this data service, but the policy was active, so you can um resubmit the claim if you'd like.
[CUSTOMER][NEUTRAL] Thank you for that. Uh, but, uh, we received the explanation of uh benefits. Can I provide you the claim number?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It is 358-9894.
[AGENT][NEUTRAL] You know what, hold on one moment. So the policy number that you gave is no longer active, um, as of [PII]. Let me look at the active policy and see if there's a claim on there. Um, the active policy number is 143.
[AGENT][NEUTRAL] 3101 and it's been active since [PII].
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, so yes, that policy, or sorry, that claim number was processed under the active claim. We received it on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Could you repeat the reason slowly, please?
[AGENT][NEGATIVE] The service is not covered?
[AGENT][NEUTRAL] When performed in a doctor's office.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Or clinic.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you for that.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh, for this one, yes, go ahead.
[AGENT][NEUTRAL] No, go ahead.
[CUSTOMER][NEUTRAL] Uh, yes, for this one, we have to, uh, can we appeal or we can send a corrected claim.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Unless the place of service changes, um, it will most likely be denied, but you have the option to appeal if you like.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, may I have the mailing address, please?
[AGENT][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Thank you for that. And uh may I have the payer ID please?
[AGENT][NEUTRAL] Sure, it's 60801.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Thank you for that. And may I have the time referring for the appeal?
[AGENT][NEUTRAL] Um, 180 days from the denial date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you for that and uh.
[CUSTOMER][NEUTRAL] May I have the call reference number for this month?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date, and again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you for that and thank you so much. And have a good day. Bye-bye.
[AGENT][POSITIVE] You're welcome
[AGENT][POSITIVE] You also, thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.