AccountId: 011433970860
ContactId: 29ccca14-99d8-4b11-8797-52fb5b4bf681
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 378980 ms
Total Talk Time (AGENT): 132194 ms
Total Talk Time (CUSTOMER): 131434 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/2025/05/08/29ccca14-99d8-4b11-8797-52fb5b4bf681_20250508T14:29_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 MASA physicians to check on a claim status.
[AGENT][NEUTRAL] OK, I can check on a claim for you. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Name of my spelling is [PII], and my last name initial is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Callback number is [PII] direct line.
[CUSTOMER][NEUTRAL] What do you think.
[AGENT][NEUTRAL] Thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number is D as in Delta 437.
[CUSTOMER][NEUTRAL] 03856
[AGENT][NEUTRAL] OK, so [PII], that's not one of our policy numbers. That is through, uh, they're called 90 degree benefits. I can give you their information, um, or if you have the member's social, I could see if they have a policy with us.
[CUSTOMER][NEUTRAL] Yeah sure, member social is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] One moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And what was the name for this number?
[CUSTOMER][NEUTRAL] Member name is [PII] and date of birth, [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that uh was this claim was this for uh medical or dental?
[CUSTOMER][NEUTRAL] Medical.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Data Services, [PII].
[CUSTOMER][NEUTRAL] For the bill amount of.
[CUSTOMER][NEUTRAL] $56 even.
[AGENT][NEUTRAL] OK, and that was [PII] correct?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK, and before I search for this claim, uh, did you want me to go ahead and give you that correct policy number?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, let me know when you're ready for that.
[CUSTOMER][NEUTRAL] Please go ahead.
[AGENT][NEUTRAL] That is 0247.
[AGENT][NEUTRAL] 57
[AGENT][NEUTRAL] 21
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mm, got it. If you don't mind, can I get your name again? Sorry, I missed your name.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That's right, it's [PII]
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank you so much for the information, [PII].
[AGENT][NEUTRAL] Of course, OK, and so we did receive this claim one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we were unable to pay a benefit as under this policy, the uh it's only payable benefit if it was regarding a sickness, not an accident.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So this claim was denied, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] If you don't mind, could you repeat the deny reason again.
[AGENT][NEUTRAL] Sure, so for this policy, uh, it only pays a benefit if it, if it was regarding a sickness.
[CUSTOMER][NEUTRAL] Not for accident, right?
[AGENT][NEUTRAL] That's correct. If you'd like I can send you a copy of this EOD.
[CUSTOMER][NEUTRAL] The claim
[CUSTOMER][NEUTRAL] Uh, sure, please. Can I go to the fax number?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, go ahead.
[CUSTOMER][NEUTRAL] Fax number is 209.
[CUSTOMER][NEUTRAL] 225
[CUSTOMER][NEUTRAL] 2174. Attention, my name is [PII]
[AGENT][NEUTRAL] OK, I'm gonna read that back to you to make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Yeah, the last four digit is 2174.
[AGENT][NEUTRAL] Got it. OK, yes, thank you. I'll go ahead and get that sent now um did you need that claim number?
[CUSTOMER][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, that is 35.
[AGENT][NEUTRAL] 82394
[CUSTOMER][NEUTRAL] Can I have the claim received it?
[AGENT][NEUTRAL] Yes, one moment.
[AGENT][NEUTRAL] That was received [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. Just give me one quick moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Thank you so much for patiently assisting.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Thank you so much for patiently waiting on the line. [PII], uh, this one is denied for uh non-covered as per the patient's plan, right?
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Got it. Can I have the reference number for this call?
[AGENT][NEUTRAL] So that would just be my first name, last initial, and today's date. Uh, so my last initial is [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] No, that's all for today, [PII]. Thank you so much for your patience justing me. Have a great day. Stay safe. Take care. Bye-bye.
[AGENT][POSITIVE] Of course, yeah, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] OK