AccountId: 011433970860
ContactId: 37fab80e-18ec-4b43-b5a7-36f0e82bdaaf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 205979 ms
Total Talk Time (AGENT): 78038 ms
Total Talk Time (CUSTOMER): 63187 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/37fab80e-18ec-4b43-b5a7-36f0e82bdaaf_20250423T16:00_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. My name is [PII]. I'm calling on behalf of the provider. I just need to check claim status.
[AGENT][POSITIVE] All right, [PII], I'm happy to check on a claim for you this morning. Can I get the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, it's uh 02563037 M as in Mary, L as in Lima, and then number 8.
[AGENT][POSITIVE] Thank you. And do you have a good callback number, [PII]?
[CUSTOMER][NEUTRAL] Yes, that's uh [PII]. It's my direct line.
[AGENT][NEUTRAL] Thank you. And may I please have patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] All right, thank you. And then what is the date of service?
[CUSTOMER][NEUTRAL] [PII] for $85 even.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] So it looks like we did receive a claim for the state of service on [PII].
[AGENT][NEUTRAL] Claim was denied [PII]. Office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] Can I have a claim number?
[AGENT][NEUTRAL] 358-4685.
[CUSTOMER][NEUTRAL] Thank you. And if my, if I may ask, what are the covered services under
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] This patient's policy.
[AGENT][NEUTRAL] So we're the secondary insurance that covers deductible, co-pay, co-insurance that the primary does not. Patient's policy will cover treatment in an office. It does not cover any sort of fee for the office visit.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] Treatment or other procedures except uh consultation, you mean?
[AGENT][NEUTRAL] I, it doesn't cover correct the office visit fee. It's only gonna cover treatment in an office setting.
[CUSTOMER][POSITIVE] Alright thank you so much. um, yeah, I think that's all I need to know. Is there a reference number for today's call?
[AGENT][NEUTRAL] Call references my name with my last initial than today's date. My name again is [PII], that's [PII] My last initial is [PII], and then today's date.
[CUSTOMER][POSITIVE] All right. OK, great, thank you so much.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][POSITIVE] You too thanks. Take care bye.
[AGENT][NEUTRAL] Bye bye