AccountId: 011433970860
ContactId: 36951b04-7c97-41ba-a9da-8f4fa6e8d994
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 271920 ms
Total Talk Time (AGENT): 115271 ms
Total Talk Time (CUSTOMER): 88069 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/36951b04-7c97-41ba-a9da-8f4fa6e8d994_20250326T18:38_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office. I'm looking on a claim status. Can you help me?
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with the claim status. [PII]. May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, the member ID is 01912842ML8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] for $300 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Integrated dermatology of South Miami.
[AGENT][NEUTRAL] It may be coming up as, it's coming up as something different. What's the tax ID? I just want to confirm.
[CUSTOMER][NEUTRAL] Uh yeah, the tax ID is [PII]. Uh, well it is uh coconut group?
[AGENT][NEUTRAL] OK, yes, it matches.
[AGENT][NEUTRAL] Yes, that's what it's showing. OK, so this is your claim. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3,567,830.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] As office visits are not covered on the policy.
[CUSTOMER][NEUTRAL] When the policy name?
[AGENT][NEUTRAL] Sure, this is the, hold on one second, it didn't pop up. This is their Medlink, their secondary gap insurance policy.
[CUSTOMER][NEUTRAL] The gap insurance. And so it's a patient responsibility?
[AGENT][NEUTRAL] Well, we don't determine patient responsibility because we're not a major medical, so it would be whatever your policies or procedures are for remaining or outstanding balances.
[CUSTOMER][NEUTRAL] OK. And uh the claim number is 3,567,830.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. Can you fax me this EOB?
[AGENT][NEUTRAL] Sure, what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And should I put attention [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, and that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, so I'll go ahead and fax this over to you now. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] May I know when I will receive this fax?
[AGENT][POSITIVE] Um, for faxes, we usually say to give it at least an hour. Um, if you don't receive it by end of day today, just let us know, we'll be more than happy to resend it for you.
[CUSTOMER][NEUTRAL] OK. Can you spell your name for me?
[AGENT][NEUTRAL] Sure, it's [PII], first initial of my last name is [PII].
[CUSTOMER][NEUTRAL] And the call reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, and the first initial of my last name is [PII].
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so much for the information you provided me on this call.
[AGENT][NEUTRAL] You're welcome, [PII].
[AGENT][POSITIVE] You're welcome. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] No, that's all for today. Thank you for asking.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] You too as well. Thank you. Bye.
[AGENT][POSITIVE] Thank you bye bye.