AccountId: 011433970860
ContactId: 313b260a-47d3-49a6-b068-15fac3695d15
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 319489 ms
Total Talk Time (AGENT): 110603 ms
Total Talk Time (CUSTOMER): 81911 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/2024/12/30/313b260a-47d3-49a6-b068-15fac3695d15_20241230T15:35_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII]. I'm calling from the doctor's office of WillMed just regards to your claim.
[AGENT][NEUTRAL] OK, [PII], can I get a good callback number?
[CUSTOMER][NEUTRAL] Sure, it's uh [PII].
[AGENT][NEUTRAL] OK, thank you [PII], can I get the policy number?
[CUSTOMER][NEUTRAL] Oh yeah, just a moment.
[CUSTOMER][NEUTRAL] It is 17641.
[AGENT][NEUTRAL] Um, let's see here. I'm not sure if that's gonna be our policy number, [PII], but give me just a second, I'll definitely take a look.
[AGENT][NEUTRAL] Yeah, that's not gonna be our policy number. If you look on the front of the insurance card, it's gonna state policy certificate number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let me check. Uh, is there any way we can pull up by the member's name and date of birth?
[AGENT][NEUTRAL] Uh, yeah, do you by chance have their social, the full social, if not.
[CUSTOMER][NEUTRAL] Uh, I just have the last 4, I believe.
[AGENT][NEUTRAL] OK, what's the member's last name [PII]?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What is your mailing address?
[CUSTOMER][NEUTRAL] [PII]. ZIP code is [PII].
[AGENT][NEUTRAL] OK, um.
[AGENT][NEGATIVE] Unfortunately that number is not gonna be in our system with that mailing address.
[AGENT][NEUTRAL] If you don't have the member ID and the correct mailing address, then I'm not gonna be able to locate that member unfortunately.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me see if I have any insurance card copy available. Just a moment.
[AGENT][NEUTRAL] Do you have, have you received any correspondence on this claim?
[CUSTOMER][NEUTRAL] Mm, not yet.
[AGENT][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Um, yeah, I do see your policy number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]. So it's 02252775.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, can you confirm the date of birth for [PII]?
[CUSTOMER][NEUTRAL] Mm, yeah.
[CUSTOMER][NEUTRAL] Back [PII].
[CUSTOMER][NEUTRAL] Just a moment, I'm pulling that up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. It is [PII].
[AGENT][NEUTRAL] OK, thank you, and you said you're calling to check claim status?
[CUSTOMER][POSITIVE] Mhm. That's right.
[AGENT][NEUTRAL] OK,
[AGENT][NEUTRAL] OK, I can definitely take a look. What's that data service and build amount?
[CUSTOMER][NEUTRAL] [PII] for the bill amount of $156.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You said [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let's see here.
[AGENT][NEUTRAL] OK, so I do have a claim number for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 353-5297.
[AGENT][NEUTRAL] It was received on [PII], processed on [PII].
[AGENT][NEGATIVE] And it was processed and denied as office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] So that will be patient responsibility on this, right?
[AGENT][NEUTRAL] Yes, it's non-covered under the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII]. Any sort of reference number for call?
[AGENT][NEUTRAL] It's gonna be my name [PII] with the first initial to my last name [PII], and today's date. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Uh, no, that's it for me. Thank you.
[AGENT][POSITIVE] OK well thank you for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] Yes, sir, bye for now.
[AGENT][NEUTRAL] All right bye bye.