AccountId: 011433970860
ContactId: 37afe42a-ecb3-4f8e-86a5-0171c7da42e2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 275790 ms
Total Talk Time (AGENT): 126831 ms
Total Talk Time (CUSTOMER): 76731 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/37afe42a-ecb3-4f8e-86a5-0171c7da42e2_20250514T16:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] My name is [PII]. I'm calling for claims please.
[AGENT][NEUTRAL] OK, I could check on a claim for you. uh, [PII], can I get a good callback number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you. And do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] It is 02266763.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that and then what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That was [PII] and then do you have that bill amount?
[CUSTOMER][NEUTRAL] Oh, yes, ma'am. The billed amount of the claim is $1,964 even.
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, [PII], I appreciate your patience. Uh, so we did receive this claim. We were unable to pay a benefit as this uh service, it's not a covered diagnostic test under this member's policy.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] You said this is not a covered benefit?
[AGENT][NEUTRAL] Right, it's not a covered diagnostic test under this policy.
[AGENT][NEUTRAL] And if you'd like I can send you a copy of this EOB.
[CUSTOMER][NEUTRAL] Yes ma'am, could you provide me with the claim number?
[AGENT][NEUTRAL] Sure, that's 356 6.
[AGENT][NEUTRAL] 623.
[CUSTOMER][NEUTRAL] 683, you said?
[AGENT][NEUTRAL] Uh, so it's 356-662-3.
[CUSTOMER][NEUTRAL] 22, thank you. And when was this process?
[AGENT][NEUTRAL] Uh, one moment, let me get that for you.
[AGENT][NEUTRAL] This claim was processed uh [PII].
[CUSTOMER][NEUTRAL] So, um, is this applied to patient responsibility?
[AGENT][NEUTRAL] We do not say what is patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] OK. So,
[CUSTOMER][NEUTRAL] Is it most likely denied because we need to submit a corrected claim?
[AGENT][NEUTRAL] No, ma'am, so this is a limited.
[CUSTOMER][NEUTRAL] By changing your diagnosis.
[AGENT][NEUTRAL] No, this is a limited indemnity medical plan, so it is limited and very specific as to what is and is not covered, right? So the specific uh diagnostic test, it does list out in the member's policy of the specific diagnostic tests that are covered. Any other kinds are not going to be covered under this policy.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got you. All right. Thank you. Um, could you please fax that EOP to my fax number whenever you're ready, I could provide you this.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] Absolutely.
[AGENT][POSITIVE] Of course, yes, I'm ready for that when you are, uh huh.
[CUSTOMER][NEUTRAL] 832
[CUSTOMER][NEUTRAL] 280
[CUSTOMER][NEUTRAL] 8224.
[AGENT][NEUTRAL] OK, I'm gonna read that back to you to make sure I heard that correctly. That was [PII]?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, I will go ahead and get that sent now. Should get it within about 10 minutes or so. And was there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] Appreciate it.
[CUSTOMER][NEUTRAL] Can you please provide me your reference number?
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial, and today's date. Uh so my name is spelled [PII]
[CUSTOMER][POSITIVE] Appreciate it. Thank you.
[AGENT][POSITIVE] Absolutely, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye.