AccountId: 011433970860
ContactId: 3b4e99aa-d6cb-4694-bb9a-6b3e003a8492
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 345820 ms
Total Talk Time (AGENT): 119363 ms
Total Talk Time (CUSTOMER): 98295 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/3b4e99aa-d6cb-4694-bb9a-6b3e003a8492_20250107T14:55_UTC.wav
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[AGENT][NEUTRAL] For calling American Public Life, this is [PII]. How may I help you?
[AGENT][POSITIVE] Good morning. Thank you for calling. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from Sun Cream Clinic to check on a green status. Can you hear me?
[AGENT][NEUTRAL] I can verify claim status. May I have a policy number?
[CUSTOMER][NEUTRAL] It is 2250022.
[AGENT][NEUTRAL] May I have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII] with the [PII] [PII].
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] May I have a date of service?
[CUSTOMER][NEUTRAL] Sure, the date of service is [PII] for $1330 even.
[AGENT][NEUTRAL] Thank you for future reference, you may visit our website at [PII] to check claim status as well. One moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Sure.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] This processed under the claim number?
[AGENT][NEUTRAL] 349-3393.
[AGENT][NEGATIVE] Looks like no benefits are payable.
[AGENT][NEUTRAL] This is not a sickness or injury, and they do not have the office treatment rider.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] So this claim was not covered.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] OK, can you provide me the claim receipt date and the process date?
[AGENT][NEUTRAL] Claim was received on [PII]. Claim denied on [PII].
[CUSTOMER][NEUTRAL] And what is the reason for the dinner?
[AGENT][NEGATIVE] There are no benefits for office treatment.
[AGENT][NEUTRAL] And this looks like it's not an illness or injury. This policy only covers illness or injury.
[AGENT][NEGATIVE] So it's not covered.
[CUSTOMER][NEUTRAL] And it covers illness and injury, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] So the CPT code 81003 and 85018, these are not come under injury or illness.
[AGENT][NEUTRAL] OK, so that was no office treatment.
[AGENT][NEUTRAL] So there's no office treatment benefits.
[AGENT][NEUTRAL] But looks like both of these were for wellness, so it was not covered. It's not an illness.
[CUSTOMER][NEUTRAL] You will only call.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] These two coats are wellness cos.
[AGENT][NEUTRAL] It is not for an illness or injury.
[AGENT][NEGATIVE] It's not covered under this policy.
[CUSTOMER][NEUTRAL] OK. So you will only cover the offices quotes. That's what you're saying?
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] [PII], could you repeat that?
[CUSTOMER][NEUTRAL] You will only cover office visit quotes?
[AGENT][NEUTRAL] This policy does not have office treatment benefits, so it's not covered.
[CUSTOMER][NEUTRAL] I just need to cross verify whether you will only
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] I'm not understanding your question.
[CUSTOMER][POSITIVE] Thank you so much, got it. So this quotes are not covered under the patient's plan, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. I request you to send a copy of CU via fax. Is that possible?
[AGENT][NEUTRAL] May I have a fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. I'll fax this right over. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, I couldn't get your name. Can you please spell it for me?
[AGENT][NEUTRAL] It's [PII] Last initial is [PII] along with today's date.
[CUSTOMER][POSITIVE] Thank you so much for your assistance. Have a great day.