AccountId: 011433970860
ContactId: 27e5f2b4-394c-4ca3-92bb-4ceffe23f900
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 228100 ms
Total Talk Time (AGENT): 86648 ms
Total Talk Time (CUSTOMER): 60358 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/27e5f2b4-394c-4ca3-92bb-4ceffe23f900_20250320T13:55_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII]. I'm calling from P's office to check the claim status.
[AGENT][NEUTRAL] OK, I help with the with that policy number, please.
[CUSTOMER][NEUTRAL] Yeah, sure. One moment.
[CUSTOMER][NEUTRAL] Yeah, the number is 02475819.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, the member's name is [PII], and the date of birth is [PII].
[AGENT][POSITIVE] I appreciate that. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you. And you said that there was a uh data service that we can look for for [PII]?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII]. The total charge amount of $372 even. That's $372.
[AGENT][NEUTRAL] Thank you. The uh claim number for this is 349.
[AGENT][NEUTRAL] 661-3.
[AGENT][NEUTRAL] And it looks like we received uh that claim.
[AGENT][NEUTRAL] On um
[AGENT][NEUTRAL] Right in here.
[AGENT][NEUTRAL] Apologize. OK, it looks like we received the claim on the [PII] and we processed it on the [PII]. Now, um, this policy doesn't cover office visits at all.
[AGENT][NEUTRAL] Uh, so no office visit is going to be covered um under this policy.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] So, may I know the plan name for this member?
[AGENT][NEUTRAL] Uh, yes, it's um it's a gap insurance it's APL.
[CUSTOMER][NEUTRAL] One moment
[CUSTOMER][NEUTRAL] Gap insurance in EPO, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And what are the services are covered under the patient plan? Is there any specific services, which means ambulance or um emergency? Yeah, sure, about that.
[AGENT][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] Sure. Um, so, uh, outpatient hospital, um, treatment within a physician's office, uh, cancer treatment.
[AGENT][NEUTRAL] Um, independent labs, durable medical, that's covered. Um,
[AGENT][NEUTRAL] And, uh, inpatient hospital stays, that is covered as well.
[AGENT][NEUTRAL] Just, just not that office visit. So treatment within the physician's office is covered, but not the uh
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] information. One moment.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Uh thank you so much for patiently waiting. So, can I get the call reference number for this call?
[AGENT][NEUTRAL] My name is [PII]. The first letter of my last name is [PII], and we're gonna use that in today's date as a reference. Is there anything else at all that I may help with?
[CUSTOMER][NEUTRAL] Mhm, one moment.
[CUSTOMER][NEUTRAL] So the claim number ends with 613, right?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Thank you so much for your assistance, [PII]. Have a great day. Bye for now. That's a day.
[AGENT][POSITIVE] Thanks for contacting API