AccountId: 011433970860
ContactId: 33d6414d-62f3-45eb-bd10-f3a238d8d669
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 443170 ms
Total Talk Time (AGENT): 163973 ms
Total Talk Time (CUSTOMER): 107145 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/33d6414d-62f3-45eb-bd10-f3a238d8d669_20250522T14:26_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from the provider's office to check on claim status.
[AGENT][NEUTRAL] OK, you said your name is [PII], is that correct?
[CUSTOMER][POSITIVE] Yeah, that's right. It's like the color.
[AGENT][NEUTRAL] OK, and [PII], you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, sir. I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] That would be [PII]. And it's a direct line.
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] That would be um.
[CUSTOMER][NEUTRAL] Uh, just, just one moment.
[CUSTOMER][NEUTRAL] Uh, it's 0203.
[CUSTOMER][NEUTRAL] 0124.
[AGENT][NEUTRAL] OK, [PII], thank you one moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And any information [PII] that I provide today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII], and their date of birth is [PII].
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And what is the date of service and total bill amount please [PII]?
[CUSTOMER][NEUTRAL] The date of services for [PII] and the total bill amount is gonna be $522 and
[CUSTOMER][NEUTRAL] Uh, 2 cents
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this claim, let me see, this claim was received on 227.
[AGENT][NEGATIVE] And it was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number, give me one moment, [PII].
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so what, give me just one second.
[AGENT][NEUTRAL] What is the name of the provider group?
[CUSTOMER][NEUTRAL] Uh, uh, just one moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] It's a fast, fast-paced Mississippi.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Bear with me just a second, [PII]. I'm waiting for some information to load for me.
[CUSTOMER][POSITIVE] Uh, sure, [PII], take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so the claim number for this claim [PII] is 357.
[AGENT][NEUTRAL] 0363.
[AGENT][NEGATIVE] This claim was denied.
[AGENT][NEUTRAL] The reason for the denial, there's two reasons. One of them is that office visits are not covered by the above number policy. This supplemental policy brand, the member's plan does not cover office visits.
[AGENT][NEUTRAL] And the other remark code for the rest of the codes states this service is not covered when performed in a doctor's office or clinic.
[AGENT][NEUTRAL] And if you need a copy.
[CUSTOMER][NEUTRAL] OK, so, uh, may I know?
[AGENT][NEUTRAL] Mhm, go ahead with your question.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I just forgot to ask you, um.
[CUSTOMER][NEUTRAL] Um, may I know the plan type of this member?
[AGENT][NEUTRAL] This is a supplemental policy.
[AGENT][NEUTRAL] And it is called Medlik.
[CUSTOMER][NEGATIVE] So, uh, this doesn't cover, uh, office visits and, uh, uh, another denial uh reason.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] And the other denial reason states this service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And if you need a copy of the explanation of benefits with those remarks on their brown, you should be able to print that directly from our portal now that you have the claim number.
[AGENT][NEUTRAL] And the website for our portal is located at [PII].
[CUSTOMER][NEUTRAL] Say
[CUSTOMER][NEUTRAL] But that's just
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And is there anything else, Brown that I could help you with this morning?
[CUSTOMER][NEUTRAL] No, uh,
[CUSTOMER][NEUTRAL] Uh, that's all, uh, for today, [PII], uh.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What would be the initial to your last name?
[AGENT][NEUTRAL] [PII], and my name in today's date will be your call reference number.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So it's uh [PII] and the
[AGENT][NEUTRAL] Actually, I spell it [PII]
[CUSTOMER][POSITIVE] I like the eye.
[CUSTOMER][NEUTRAL] Yeah,
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Crazy [PII]
[AGENT][NEUTRAL] Mhm, that's yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And [PII], what is the first initial to your last name?
[CUSTOMER][NEUTRAL] It's 2 [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] one
[AGENT][POSITIVE] So if that is all that I could help you with, thank you very much for calling APL and I hope you have a nice day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, you too, [PII]. Have a great day. Take care.
[AGENT][POSITIVE] Thank you. You too, [PII]. Uh-huh.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.