AccountId: 011433970860
ContactId: 31bffa08-8281-4d52-b87d-26013597e225
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 301209 ms
Total Talk Time (AGENT): 86082 ms
Total Talk Time (CUSTOMER): 88680 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/31bffa08-8281-4d52-b87d-26013597e225_20250606T14:31_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], good morning. This is [PII] calling from provider's office to check on claim status.
[AGENT][NEUTRAL] I can help you with claim status [PII], can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, sure. It's uh [PII] and that's a direct line.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] OK. The policy number is 02300709 M as in Mary, L as in Lima, number 7.
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Can I get you to verify the patient's name and date of birth for me please?
[CUSTOMER][NEUTRAL] Yes, that's uh [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Thank you so much for verifying that with me.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and do you have the claim number or the date of service?
[CUSTOMER][NEUTRAL] Uh, I do have the date of service.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's April 3rd of 2025 and the claim is billed for $55 even.
[AGENT][NEUTRAL] Give me just a moment to look that up.
[CUSTOMER][NEUTRAL] Sure, sure.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is the provider's name?
[AGENT][NEUTRAL] For the hospital name?
[CUSTOMER][NEUTRAL] That's NCH.
[CUSTOMER][NEUTRAL] OK, that's NCHMD Incorporation.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] OK, I'm showing this claim was processed on [PII].
[AGENT][NEUTRAL] I'm sorry, we received it on [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] The claim number
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] It's 3589.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I'm I'm gonna do that.
[AGENT][NEUTRAL] 460.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And it looks like
[AGENT][NEUTRAL] The claim was denied because office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] About a.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEGATIVE] And then um the service that was uh that was denied is that the service is not covered when performed in a doctor's office or a clinic.
[AGENT][NEUTRAL] So they were non-covered services.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you so much. And uh give me one second. Let me just double check it, OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much for that patience. And may I know what, what plan does the member has?
[AGENT][NEUTRAL] It is a Medlink policy, so it's secondary gap insurance.
[CUSTOMER][NEUTRAL] OK. And is there any other insurance found active for the member?
[AGENT][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This is the only insurance they have through us.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, thank you so much for that. Uh, can I get a call reference number, please?
[AGENT][NEUTRAL] So we don't have call reference numbers so you can use my name and last initial in today's date, so [PII] and today's date.
[CUSTOMER][POSITIVE] Good.
[CUSTOMER][POSITIVE] OK. Thank you so much. You have a great day. Take care.
[AGENT][POSITIVE] OK, thank you for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] OK.