AccountId: 011433970860
ContactId: 2f8a9082-d9c4-4324-94c7-88f9d352743f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 309589 ms
Total Talk Time (AGENT): 109996 ms
Total Talk Time (CUSTOMER): 112662 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/2f8a9082-d9c4-4324-94c7-88f9d352743f_20250211T15:59_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh hi, [PII]. This is [PII] calling from the provider's office regarding claims.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claims, [PII]. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] I have one friend.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Um, yes, Me policy number is 02301062 and Mary and Lima number 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, my name is, uh, just a moment. It's [PII], date of birth, [PII].
[AGENT][NEUTRAL] Mhm.
[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 for the claim?
[CUSTOMER][NEUTRAL] Uh, yes, the date of service is for [PII].
[AGENT][NEUTRAL] Thank you and the total bill?
[CUSTOMER][NEUTRAL] bill for $336.26.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Uh yes, it's Genesis K USA of [PII].
[AGENT][NEUTRAL] Here it is. Thank you for that. Hold on one moment.
[AGENT][NEUTRAL] So I am showing that the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 33555336.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied as office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] OK, so is it as for the patient's plan?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, just give me a moment. And what type of plan does the patient have?
[AGENT][NEUTRAL] Um, this is the Main supplemental, um, insurance.
[CUSTOMER][NEUTRAL] Uh, supplemental.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Just give me a moment to talk.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me check that, just a moment.
[CUSTOMER][NEUTRAL] Is it a limited benefits plan, like?
[AGENT][NEUTRAL] No, it's not limited benefit, it's secondary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Mm, OK. Uh, fine. And what was the date of, uh, denial of, of the claim?
[AGENT][NEUTRAL] Um, hold on one moment.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry. Hold on one moment.
[AGENT][NEUTRAL] It's [PII] was the denial.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] OK, and received and processed on the same day.
[AGENT][NEUTRAL] Right, it was received on the [PII] and processed on the [PII].
[CUSTOMER][NEUTRAL] OK. And the claim number is 33555336, correct?
[AGENT][NEUTRAL] No, it's 355-536-90.
[CUSTOMER][NEUTRAL] OK, I'm so sorry, can you repeat that again?
[AGENT][NEUTRAL] 355-53690.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, OK, thank you for your assistance. Just help me with the reference number for the call. And also if you can please.
[AGENT][NEUTRAL] Sure, so there's no
[CUSTOMER][NEUTRAL] Uh, yes, can you fax us the EUP?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And that's [PII]?
[CUSTOMER][NEUTRAL] Yes. And can you please uh give attention to my name, [PII]? Yes.
[AGENT][NEUTRAL] Attention, [PII].
[AGENT][POSITIVE] All right, so I'm sending this over to you now, [PII]. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Uh, just give me a moment. Uh, no, nothing. Thank you for assistance. That's it.
[CUSTOMER][NEUTRAL] Right, just the reference number.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date.
[CUSTOMER][NEUTRAL] OK. And uh what is the, you are sending the fax right now?
[AGENT][POSITIVE] Yes, I'm sending it to you now.
[CUSTOMER][POSITIVE] OK, thank you. That's it. Bye.
[AGENT][POSITIVE] You're very welcome, [PII], and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah, I.