AccountId: 011433970860
ContactId: 436e5f13-dbc4-4b3e-a64f-5a7b8d5a445e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 530369 ms
Total Talk Time (AGENT): 157186 ms
Total Talk Time (CUSTOMER): 156279 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/436e5f13-dbc4-4b3e-a64f-5a7b8d5a445e_20250214T21:18_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII] calling from provider's office regarding lip service.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status, [PII]. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] with an extension of [PII]. Can you spell your name with the last name, please?
[AGENT][NEUTRAL] Sure, [PII].
[CUSTOMER][POSITIVE] Thank you [PII].
[AGENT][NEUTRAL] You're welcome. And how many claims do you have in total today, [PII]?
[CUSTOMER][NEUTRAL] Uh, only 1 kilometer trip.
[AGENT][NEUTRAL] OK. May I have the member's policy number?
[CUSTOMER][NEUTRAL] So, my policy number is uh
[CUSTOMER][NEUTRAL] Just give me a second please. I put the numbers policy number, don't mind.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, M's policy number is 02518608.
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima. Again number 8.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the member's um first and last name and date of birth?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And my first name is going to be.
[CUSTOMER][NEUTRAL] Yeah, [PII], and the last name is, is [PII]. It's [PII]
[CUSTOMER][NEUTRAL] [PII] and the last name is [PII]. Mhm.
[AGENT][POSITIVE] Thank you for that and I'll be, and
[AGENT][NEUTRAL] Again, just for the call, the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Data service is [PII] with the bill amount of
[CUSTOMER][NEUTRAL] $3,222 even.
[AGENT][POSITIVE] Thank you for that. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold while I locate the claim?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][POSITIVE] Sure, [PII], good help.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 351.
[AGENT][NEUTRAL] 255.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So we received a few claims for that data service, so I had to go through them all to find yours. I do apologize for that. Um, but we have received the claim on [PII].
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] 07
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The claim number is 35587007.
[CUSTOMER][NEUTRAL] 64491.
[CUSTOMER][NEUTRAL] Sure, got it.
[AGENT][NEUTRAL] And on [PII], the claim was denied because the service is not covered when performed by a doctor's in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] We are setting, uh.
[CUSTOMER][NEUTRAL] Just give me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The bill services like you're sitting on the CPT cos CPT codes are got in that right.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Just hold on.
[AGENT][NEGATIVE] Yes, they were all denied for the same reason. The service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, stating that the services will be not covered, which are performed in doctor's office, sir.
[AGENT][NEUTRAL] The service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK, let me correct. Can you please send me the copy of your big fax?
[AGENT][NEUTRAL] Sure, what's a good um fax number for you?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And should I put attention, [PII]?
[CUSTOMER][NEUTRAL] Yes, you can attend to AlexP.
[AGENT][NEUTRAL] [PII], P like Paul.
[CUSTOMER][NEUTRAL] P like Peter. Mhm. P S H.
[AGENT][NEUTRAL] OK, that was [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so I'll go ahead and send the
[CUSTOMER][NEUTRAL] 615, yeah, [PII].
[AGENT][POSITIVE] Thank you. So I'll go ahead and send the explanation of benefits over to you now.
[CUSTOMER][NEUTRAL] Yeah, hello?
[CUSTOMER][NEUTRAL] Yeah, can you please help me with, uh, what does, yes, I can hear you. Can you hear me?
[AGENT][NEUTRAL] Can you hear me?
[AGENT][POSITIVE] Yes. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Actually, I do have one more question for this claim. Uh, may I know the, what does the member plan? Would you please help me the member's plan name?
[AGENT][NEUTRAL] Yes, it's a Medlink supplemental gap insurance.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Of smelling supplementary gap policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure, can you please, uh, send a copy of your B through fax and uh the call reference is 35587 no the the claim number. I'm sorry, it's 355-8707. Am I right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, that's it all the information. Can you please help me the call reference?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Yeah, how many days like to receive any be, how much time it gonna take?
[AGENT][POSITIVE] Um, when we send a fax it's at least an hour, um, but if you do not receive it by end of business day today, you can definitely give us a call back and we'll be more than happy to resend it for you.
[CUSTOMER][NEUTRAL] So actually you, you have been sent the fax. I'm sorry, you have been sent the claim through fax right now.
[AGENT][NEUTRAL] Sir, I, I'm, I'm literally I'm, I'm typing in the digits to fax it to you now. I just haven't pressed send yet. I just have to get it together. So I'm I'm getting ready to send it to you right now. If you haven't received it by the end of the day, just give us a call and we can resend it, but I'm about to press send for you right now.
[CUSTOMER][NEUTRAL] So it might be get within.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sure, thank you. That's all the information I need. Thanks.
[AGENT][POSITIVE] You're welcome. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Nothing else, bye for now.
[AGENT][POSITIVE] Alright, well thanks so much for calling APO. Bye bye.