AccountId: 011433970860
ContactId: 403c23ba-61c7-4e94-a0e7-4e5c05502ac2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 320529 ms
Total Talk Time (AGENT): 136708 ms
Total Talk Time (CUSTOMER): 83572 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/403c23ba-61c7-4e94-a0e7-4e5c05502ac2_20250625T19:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Compass Health, and I have a question on um a policy to see if it covers office visits.
[AGENT][NEUTRAL] OK, yeah, I can see if office visits are covered. Um, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] extension 151.
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Huh?
[CUSTOMER][NEUTRAL] 02230101
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Bear with me for a date of birth here just a second. I need to get in a different screen.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Sorry about that.
[AGENT][POSITIVE] You're OK.
[CUSTOMER][NEUTRAL] A.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect thank you so much for verifying that. Alright, uh, so of course this policy is uh.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh, that effective date was [PII]. And if you'll give me one moment, I will check those benefits. Give me just a minute.
[CUSTOMER][NEUTRAL] Yeah bye bye.
[AGENT][NEUTRAL] OK, uh, and of course I will let you know verification of coverage is not a guarantee of payment for claims. So under this policy, office visits are not covered, however, treatment received in office is.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Shouldn't be uh covered for the visit itself.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so I have an office visit and an X-ray that was done in an urgent care, so that will be covered.
[AGENT][NEUTRAL] Urgent care is different. Give me just a moment. That's not gonna be considered, uh, like a physician's office or a clinic. Uh, bear with me just a moment. That should be.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The visit should be covered for that one. Give me just a moment though, I'll just verify.
[AGENT][POSITIVE] I apologize it is taking its time.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, urgent care facility is covered under their outpatient benefits, so that should not be an issue. Um, office visits would be considered more, you know, a physician's office or like a clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, so we submitted a claim and it came back saying that you guys needed the explanation of benefits. Um, my guess is that try to go electronic, so we sent that paper for Randolph. It was a claim for data service [PII], and we sent it paper in on [PII].
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] One minute.
[CUSTOMER][NEUTRAL] Can you see if you have that?
[AGENT][NEUTRAL] OK, give me just a moment let me see if I'll get an update of course give me just a moment.
[AGENT][NEUTRAL] That date of service you said [PII]?
[CUSTOMER][NEUTRAL] Yes,
[AGENT][NEUTRAL] OK, now I am not showing that that has been received. I just have that original claim information so I do have I can go ahead and give you our um mailing address and fax number just to make sure that that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, OK, yeah.
[AGENT][NEUTRAL] OK, so our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, that's exactly where we mailed our claim. Let's try a fax number if I may.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Absolutely, uh, that is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, we will fax that all right I appreciate your time thank you very much.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Absolutely, yeah. Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Not at this time thanks again.
[AGENT][POSITIVE] Alright, thanks for calling APL have a great rest of your day.
[CUSTOMER][POSITIVE] OK thanks you too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.