AccountId: 011433970860
ContactId: 4418e9b0-e144-415e-b02c-ec8d9849735e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 478739 ms
Total Talk Time (AGENT): 171015 ms
Total Talk Time (CUSTOMER): 190168 ms
Interruptions: 9
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/4418e9b0-e144-415e-b02c-ec8d9849735e_20250520T18:36_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Hey, hi, this is [PII] from the doctor's office to check on the claim status.
[AGENT][NEUTRAL] I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEGATIVE] I'm so sorry, but there is something in the background that is causing me to not be able to understand you at all.
[CUSTOMER][NEUTRAL] No, that she might be the of the party.
[CUSTOMER][NEUTRAL] Sorry for that. Is it better now?
[AGENT][NEUTRAL] Uh, yes. And what is your name again? No, I can't remember, no, sir.
[CUSTOMER][NEUTRAL] for any boy in there.
[AGENT][NEUTRAL] I, I cannot hear you over the background.
[CUSTOMER][NEUTRAL] Sure, sure, uh, can you, is it better now?
[AGENT][NEUTRAL] At at the moment.
[CUSTOMER][NEUTRAL] Yeah. My name is [PII] last name first [PII] [PII].
[AGENT][POSITIVE] OK, [PII], how can I help you today?
[CUSTOMER][NEUTRAL] I'm just looking for claim status.
[AGENT][NEUTRAL] OK, you're needing claim status, is that correct?
[AGENT][NEUTRAL] [PII], did you say that you need claim status?
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] I can help you with that, [PII]. What is your callback number?
[CUSTOMER][NEUTRAL] Sure, callback number is [PII], no extension direct line.
[AGENT][NEUTRAL] Thank you. And how many claims do you have to check status on?
[CUSTOMER][NEUTRAL] Yeah, I do have only one.
[AGENT][NEUTRAL] OK, and what is that member's policy number?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Sure, the member's policy number is going to be.
[CUSTOMER][NEUTRAL] Just give me one moment.
[CUSTOMER][NEUTRAL] Yeah, it's 02521722.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] with the date of birth [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And also I didn't catch your name. Can you spell your name for me for documentation purpose?
[AGENT][NEUTRAL] Yes, my name will also be your call reference number along with today's date and it's [PII] last name [PII].
[CUSTOMER][NEUTRAL] It is.
[AGENT][NEUTRAL] And again, uh, if you could please verify your patient's name and date of birth.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII] with the [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, thank you. And the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] with the total bill amount is $421 even.
[AGENT][NEUTRAL] And did you say the data service was 213?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. 213 2025 with the total bill amount is.
[AGENT][NEUTRAL] February
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the tax ID number please?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The tax ID number?
[CUSTOMER][NEUTRAL] Sorry, what number you are?
[AGENT][NEUTRAL] Tax identification number.
[CUSTOMER][NEUTRAL] Sure, the tax ID is
[CUSTOMER][NEUTRAL] Yeah, the tax identification number what I have here is [PII].
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Your name is.
[CUSTOMER][NEUTRAL] The 100 that's the 1000.
[AGENT][NEUTRAL] So this
[AGENT][NEUTRAL] This claim was received on [PII].
[AGENT][NEUTRAL] Denied on [PII].
[AGENT][NEUTRAL] The claim number is 358.
[AGENT][NEUTRAL] 325 8.
[AGENT][NEUTRAL] And the reason for the denial on this claim, [PII] states.
[CUSTOMER][NEUTRAL] Basically.
[AGENT][NEUTRAL] Benefits payable under this certificate are limited to those outlined on the schedule of benefits. This is not a covered loss under the plan. Therefore, no amount is payable for this expense.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] This is not covered under the member's plan.
[CUSTOMER][NEUTRAL] Is it uh the primary?
[AGENT][NEUTRAL] Under the member's plan.
[CUSTOMER][NEUTRAL] Yeah, the primary process, mhm, yes, if the primary has been processed and paid, the patient responsibility for insurance, it doesn't cover the secondary, right?
[AGENT][NEUTRAL] The secondary does not cover the service, that is correct.
[CUSTOMER][NEUTRAL] I got it. Can I get the claim number?
[AGENT][NEUTRAL] Do you need for me to repeat that again? 3583258?
[CUSTOMER][NEUTRAL] Can I get the
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] I'm I'm.
[CUSTOMER][NEUTRAL] I got it.
[AGENT][NEUTRAL] And if you need a copy of that explanation of benefits, [PII], with that remark on it, you may print that by going to our portal which is located at [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I got it and primary responsibility is not covered kind, right?
[AGENT][NEUTRAL] We do not, I'm sorry, we do not, say that again because again that background noise is preventing me from understanding you, [PII].
[CUSTOMER][NEUTRAL] I'm talking about.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sorry for that. Sorry for that. The primary patient responsibility is not covered by the secondary, right?
[AGENT][NEUTRAL] Yes, this policy does not provide a benefit for that, and APL does not determine patient responsibility. That would be up to the provider.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] And is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] What is that plan name sorry for that.
[AGENT][NEUTRAL] This is a Medin supplemental policy.
[CUSTOMER][NEUTRAL] I it's something like.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Is that
[AGENT][NEUTRAL] And is there anything else, [PII], that I can help you with?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, patients link W benefits assignment, right?
[AGENT][NEGATIVE] I didn't understand you.
[CUSTOMER][NEUTRAL] Can I get the call reference number?
[AGENT][NEUTRAL] Yes, as I explained to you initially, it would be my name with today's date.
[CUSTOMER][POSITIVE] I got it. That's it for today. Have a great day. Be safe. Bye for now.
[AGENT][NEUTRAL] OK.