AccountId: 011433970860
ContactId: 30ad466a-b7c8-43d0-a719-d3f9c1ed2baa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 502619 ms
Total Talk Time (AGENT): 174783 ms
Total Talk Time (CUSTOMER): 200254 ms
Interruptions: 7
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/30ad466a-b7c8-43d0-a719-d3f9c1ed2baa_20250314T15:20_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, hi, this is [PII]. I'm calling from provider's office. I would like to discuss two claims only.
[AGENT][NEUTRAL] OK, and how do you spell your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have a callback number just in case we get disconnected.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and you said you need claim status. And may I have the policy number?
[CUSTOMER][NEUTRAL] Yeah, sure, why not? Uh, the policy number is 02369694.
[AGENT][NEUTRAL] OK and you're calling from which facility for my notation?
[CUSTOMER][NEUTRAL] Lotus psychiatry and wellness.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] The patient name is [PII].
[CUSTOMER][NEUTRAL] [PII] or [PII], I don't know what is uh how do you pronounce it? [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII], mhm.
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. May I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The first data of service that I have here is uh [PII]. Total amount billed was $540 even.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] By the way, do you, uh, familiar with the web portal available as of APL?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But uh actually what if we don't have uh the social security number so in case of uh you know.
[CUSTOMER][NEUTRAL] We don't have the social security number so we can't check the claim status over the internet, right?
[AGENT][NEUTRAL] If you don't have all the information that is requested, no, you have to call and get a claim number and then you can just pull the information with the claim number and print it out.
[CUSTOMER][NEUTRAL] If you don't have all the information you would.
[CUSTOMER][NEUTRAL] with the number.
[CUSTOMER][NEUTRAL] So which number should I have to call?
[AGENT][NEUTRAL] You're calling the correct number.
[CUSTOMER][NEUTRAL] Uh, is it the IVR?
[AGENT][NEUTRAL] Mm, no.
[CUSTOMER][NEUTRAL] OK, let's discuss this claim first.
[AGENT][NEUTRAL] You're calling the question.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Um, and you said the first claim was for [PII], correct?
[CUSTOMER][NEUTRAL] Right, um, and you said the first name was.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, I don't have that claim on file.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Seriously, uh, you don't have the claim on file?
[AGENT][NEUTRAL] Let me check and see if I got the right policy number pulled up because it looks like there's more than one policy for this.
[CUSTOMER][NEUTRAL] Can you please
[AGENT][NEUTRAL] Family, one moment.
[AGENT][NEUTRAL] 16
[AGENT][NEUTRAL] Do you have any other policy numbers?
[CUSTOMER][NEUTRAL] Do you have any other?
[CUSTOMER][NEUTRAL] Uh, let me just check.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, I gave you 02369694. Am I correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Uh, that is the only, you know, member ID that I have here and.
[AGENT][NEUTRAL] OK, yeah, that's, that's incorrect, but let me go ahead and look at the new 11 moment.
[CUSTOMER][NEUTRAL] OK, OK. Uh just.
[CUSTOMER][NEUTRAL] Uh, look at this one, like policy number 02395578.
[AGENT][NEUTRAL] OK, no, that's also it terminated.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] OK, I have a different one bear with me I'm searching for your claim on the new one.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I did find this claim, um, and this is gonna be processed on [PII].
[CUSTOMER][NEUTRAL] Get plenty of time.
[CUSTOMER][NEUTRAL] Um, is this gonna be.
[AGENT][NEUTRAL] And the claim was denied?
[AGENT][NEGATIVE] The reason for this denial.
[CUSTOMER][NEUTRAL] waiting for this
[AGENT][NEUTRAL] Is that office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Office visits are not covered, uh.
[AGENT][NEUTRAL] Another member's plan.
[AGENT][NEUTRAL] Do you need the claim number?
[CUSTOMER][NEUTRAL] Uh, yeah, of course.
[AGENT][NEUTRAL] OK, the claim number is 354.
[AGENT][NEUTRAL] 5047. Again, that's 3545047, and you can use that to pull the image of the EOB on the web portal.
[CUSTOMER][NEUTRAL] This claim was denied due to office visits are not covered under
[AGENT][POSITIVE] Patients plan. Mhm, yes, correct.
[CUSTOMER][NEUTRAL] The member's plan, right?
[CUSTOMER][NEUTRAL] OK, really, maybe some, uh, there is an EOB that some data services you guys have paid for it.
[AGENT][NEGATIVE] We cover for procedures, we do not cover for the office visit. This one is for an office visit. It's not covered.
[CUSTOMER][NEUTRAL] OK, so what about [PII]?
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] In [PII] and it's for the same amount for 5 $540. Um, yeah, we did not pay. It's the same denial, office visits are not covered by the policy.
[AGENT][NEUTRAL] The claim number on this one.
[AGENT][NEUTRAL] It's um 355-57007.
[CUSTOMER][NEUTRAL] 355-57007
[AGENT][NEUTRAL] Mhm. Sure. Yeah.
[CUSTOMER][NEUTRAL] So it was also processed on [PII] or is it processed on some other date?
[AGENT][NEUTRAL] Let me check the date of the process on this one.
[AGENT][NEUTRAL] OK, this one was processed on [PII].
[CUSTOMER][NEUTRAL] OK, and, uh, by the way, how do you spell your street name?
[AGENT][NEUTRAL] My name is [PII]. Th[PII].
[CUSTOMER][NEUTRAL] Oh, so your name is [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So is there any caller for somebody you want to give me so?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you would like, Mr. [PII].
[CUSTOMER][POSITIVE] With pleasure, I will use your name with today's date. Thank you so much for assisting me.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No thank you. uh I really appreciate it, by the way.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Likewise, bye bye.
[AGENT][NEUTRAL] Bye bye.