AccountId: 011433970860
ContactId: 3334a8ae-092a-4a02-b54b-8cacabbe4ecb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 200020 ms
Total Talk Time (AGENT): 88626 ms
Total Talk Time (CUSTOMER): 68672 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/3334a8ae-092a-4a02-b54b-8cacabbe4ecb_20250211T20:52_UTC.wav
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[AGENT][NEUTRAL] Contacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. I'm calling regarding a denial that you received for a claim.
[AGENT][NEUTRAL] OK, I can certainly look that up. What is the um policy number, please?
[CUSTOMER][NEUTRAL] 02346482.
[AGENT][POSITIVE] Thank you, and I'm sorry, I didn't catch your name.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so, what is the um insured's name and date of birth, please?
[CUSTOMER][NEUTRAL] Um, [PII], [PII].
[AGENT][POSITIVE] OK, thank you very much. I'll look that up now. And is there a um callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Uh, yeah, yeah. Uh, my direct line is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] I appreciate that. Thank you. What is the date of service that we're looking for for um [PII]?
[CUSTOMER][NEUTRAL] Um, [PII]. The total bill is
[CUSTOMER][NEUTRAL] $241.
[AGENT][POSITIVE] OK, I appreciate that. Thank you. The claim number is 3559707.
[AGENT][NEGATIVE] And uh the denial on this was that there was no office visit coverage on these policies. Um, the policies don't cover any sort of office visit at all.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, so it, it's, uh,
[AGENT][NEUTRAL] The it a secondary, uh, we just don't cover the office visits.
[CUSTOMER][NEGATIVE] Mm, no office visit coverage for this plan.
[AGENT][NEUTRAL] Right, for by by his, uh, by his policy, right. So we received it on the [PII]. We processed that on the [PII], but um there is no coverage for uh office visits on these uh on these policies.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] No just
[AGENT][NEUTRAL] Is this the only claim that we're looking at or?
[CUSTOMER][NEUTRAL] Um, I have
[CUSTOMER][NEUTRAL] Yeah, when you said that I checked the other date, we have another one for [PII]. I'm not sure if that's the same case.
[CUSTOMER][NEUTRAL] The billed amount is 70, December [PII], 2024.
[AGENT][NEUTRAL] December the
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, on this one, I have treatment within a physician's office, um.
[AGENT][NEUTRAL] And it looks like that one was paid, so let me, let me look at that one again, um, 513.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And what was the, the bill amount, please?
[CUSTOMER][NEUTRAL] Uh, OK, sorry. I, I just saw the, I called on [PII]. Uh, never mind, thank you.
[AGENT][NEUTRAL] OK, is there anything else at all I can help with?
[CUSTOMER][NEUTRAL] For the other
[CUSTOMER][POSITIVE] Uh, no, that's all. Thank you so much. Oh, no, the call reference number? Do I have it already?
[AGENT][NEUTRAL] Yes, my, my name is [PII]. The first letter of my last name is [PII], and we're gonna use that today's date as a reference.
[CUSTOMER][POSITIVE] Thank you have a good one.
[AGENT][POSITIVE] OK, so thanks for contacting A