AccountId: 011433970860
ContactId: 42622be2-91d4-4f55-b5a3-9b4b8e168b69
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 374019 ms
Total Talk Time (AGENT): 109574 ms
Total Talk Time (CUSTOMER): 54718 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/42622be2-91d4-4f55-b5a3-9b4b8e168b69_20250521T17:16_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thanks for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Uh yes, my name is [PII]. I'd like to speak with someone in regards to claim status.
[AGENT][NEUTRAL] OK, yes, ma'am. I'll verify claim status for you and you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is that policy number, please?
[CUSTOMER][NEUTRAL] I have 01742602.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you, ma'am. And give me one moment, please.
[AGENT][NEUTRAL] Uh, what is the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Station is [PII], 613-62. May I have your name, please?
[AGENT][NEUTRAL] Yes, ma'am. It's [PII] last initial. Yes, ma'am. Oh Lord, I just thought of [PII].
[CUSTOMER][POSITIVE] Hey, OK, thank you.
[AGENT][NEUTRAL] Let's see what's the data service and amount of the charge?
[CUSTOMER][NEUTRAL] I have 1 23 25 for $200.
[AGENT][NEUTRAL] And do you have the balance after primary?
[CUSTOMER][NEUTRAL] 6523.
[AGENT][NEUTRAL] 6523. Thank you. Give me one moment.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] And what is the name of the provider's office?
[CUSTOMER][NEUTRAL] Washington University.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] 411.
[AGENT][NEUTRAL] Sorry, I'm taking a while to pull and see if we can proceed the claim.
[AGENT][NEUTRAL] And I apologize, what's the name of the provider's office again?
[CUSTOMER][NEUTRAL] She's in university.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] I don't show we received that claim. Uh, can you verify the address it was submitted to?
[CUSTOMER][NEGATIVE] It looks like there's a denial.
[AGENT][NEUTRAL] Uh, do you have a claim number?
[CUSTOMER][NEUTRAL] 356-532-0
[AGENT][NEUTRAL] OK, well, this one looks like it's for a different provider.
[AGENT][NEUTRAL] Division of radiology, uh, radiation oncology.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh-huh. Yes, it's the same. Washington University or Division of Radiation Oncology under nurse practitioner [PII].
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] OK, see.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Benefits payable under the certificate are limited to those outlined in the schedule of benefits. This is not a covered loss under the plan. Therefore, benefits are not payable.
[AGENT][NEUTRAL] Well, it looked like it was for an office visit, um.
[CUSTOMER][NEUTRAL] Office visit, yeah.
[AGENT][NEUTRAL] Uh, see.
[AGENT][NEUTRAL] OK, yeah, with this patient policy office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And be patient's responsibility.
[AGENT][NEUTRAL] Um, it's not covered. We can't give patient responsibility. We can only verify how it's processed, but it's not a covered benefit under their plan.
[CUSTOMER][NEUTRAL] Can I have a reference number?
[AGENT][NEUTRAL] Uh, if you like, you may use my name in today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Alright, you're welcome. Thank you for calling APM Ms [PII]. Have a great day.
[CUSTOMER][NEUTRAL] You do the same.
[AGENT][NEUTRAL] Bye.