AccountId: 011433970860
ContactId: 2d4fe126-2052-41ba-9abf-03c3ca442cb6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 268059 ms
Total Talk Time (AGENT): 125738 ms
Total Talk Time (CUSTOMER): 84159 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/2d4fe126-2052-41ba-9abf-03c3ca442cb6_20250326T19:21_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from B's office. How are you doing today?
[AGENT][POSITIVE] I'm doing good, [PII]. How about you today?
[CUSTOMER][NEUTRAL] I'm fine, and if you don't mind, could you spell your name for me?
[AGENT][NEUTRAL] I sure can, [PII]. It's [PII] yes. And how can I help you today, [PII]?
[CUSTOMER][NEUTRAL] Uh, thank you for that. And if you don't mind, could you provide me a claim for the patient, please?
[AGENT][NEUTRAL] I'm sorry, what was I saying?
[CUSTOMER][NEUTRAL] Uh, I need a claim status for the patient.
[AGENT][NEUTRAL] OK, status. OK, I thought that's what you said, Want to make sure. OK, go ahead and give me a good policy number, [PII].
[CUSTOMER][NEUTRAL] Yeah, the policy number would be 01960541 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] Alrighty, thank you for that, [PII]. Now while I'm pulling this up, go ahead and give me a good return telephone call number, please, sir.
[CUSTOMER][NEUTRAL] So it's [PII].
[AGENT][NEUTRAL] Alrighty, [PII], thank you for all that information. Now, what's your patient's name and date of birth today, please, sir?
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and last name is spelled as [PII].
[CUSTOMER][NEUTRAL] Also, date of birth would be [PII].
[AGENT][NEUTRAL] I understand, thank you for all that information. Now you did say you want to check status of a claim. What's your data service?
[CUSTOMER][NEUTRAL] D of service would be 128 of 25.
[AGENT][NEUTRAL] 128. And how much is your bill for [PII]?
[CUSTOMER][NEUTRAL] Bill amount is $863 even.
[AGENT][NEUTRAL] Alright, [PII], give me just a moment. Let's see what we have.
[AGENT][NEUTRAL] Hm.
[AGENT][NEGATIVE] Well, it looks like we do have that claim in-house, but now it's being denied as routine, it's not covered. So the diagnosis that was submitted is not a covered benefit here at all under their plan.
[AGENT][NEGATIVE] So it's being denied.
[CUSTOMER][NEUTRAL] So you're saying that
[CUSTOMER][NEUTRAL] OK, it's dinner for routine exams not covered because the diagnosis.
[AGENT][NEUTRAL] Correct, we don't pay for anything routine here at all, no matter what.
[CUSTOMER][NEUTRAL] OK, so you're not going to cover this claim, OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, so could, if you don't mind, could you provide me the date and the denial date, please?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, let me get over to that screen. I sure can.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Well, let's say we received this claim on [PII], denied on [PII].
[CUSTOMER][NEUTRAL] And could you provide me the claim number, please?
[AGENT][NEUTRAL] Yes, your claim number is 356-8466.
[CUSTOMER][NEUTRAL] Uh, could you verify it's 356-8466 right?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Is there anything else that I can help you with on this claim, [PII]?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yeah, thank you for that. And if you don't mind, uh, could you provide me the number for this claim, please?
[AGENT][NEUTRAL] Well, we do not give call reference number, [PII], but you can use my name and today's date and my name is spelled [PII] yes, [PII].
[CUSTOMER][NEUTRAL] And today's date, right?
[AGENT][NEUTRAL] In today's date, that is correct.
[CUSTOMER][POSITIVE] Thanks, uh, thank you for that, and by the way, thank you for asking me out and have a great day.
[AGENT][POSITIVE] You as well, [PII], and thanks for calling APO. Have a great day. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye bye bye.