AccountId: 011433970860
ContactId: 47f6c79c-8408-44e0-975d-8ec46cf8fa28
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 379089 ms
Total Talk Time (AGENT): 159324 ms
Total Talk Time (CUSTOMER): 65400 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/47f6c79c-8408-44e0-975d-8ec46cf8fa28_20250311T20:40_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 was calling to check the status of a medical claim.
[AGENT][NEUTRAL] OK, you're calling on behalf of a provider to check the status of a medical claim, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII] and I'm calling from Southwest Orthopedic Specialists.
[AGENT][POSITIVE] OK, [PII], thank you. And what is a good callback number for you please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] That is
[CUSTOMER][NEUTRAL] 01888653
[AGENT][NEUTRAL] OK, thank you, [PII]. One moment, please.
[AGENT][NEUTRAL] And [PII], any information that I provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] That is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, maybe I misheard the policy number?
[AGENT][NEUTRAL] 01888653
[CUSTOMER][NEUTRAL] Yes, that's what we were given.
[AGENT][NEUTRAL] OK, there's, yes, ma'am, there's no one by that name on this policy and this policy is not active.
[AGENT][NEUTRAL] Do you have any other information to look up the number?
[CUSTOMER][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Is she the subscriber?
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] And again, 01888653.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] Mm, so that's not a valid.
[CUSTOMER][NEUTRAL] I'm calling to see if I can find a copy of the card.
[AGENT][NEGATIVE] Yeah, that's not gonna be the correct policy number.
[AGENT][NEUTRAL] I can try by that. What's the last name again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] The subscriber is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] And again, the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient is [PII].
[CUSTOMER][NEUTRAL] And date of birth for her is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Data service 4 24 23 for $90.
[AGENT][NEUTRAL] OK, so I did locate a policy. So the current policy number that they have, it's no longer active, but the, where you have
[AGENT][NEUTRAL] 653.
[AGENT][NEUTRAL] It should be 633.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK.
[AGENT][NEUTRAL] OK, and this policy was active from [PII].
[AGENT][NEUTRAL] But let me see if we did receive the claim and process it.
[AGENT][NEUTRAL] And you said it was [PII]?
[AGENT][NEUTRAL] With the data service, OK, and total bill amount $90.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so we did receive a claim for her for that data service. Uh, the claim was received on [PII].
[AGENT][NEUTRAL] It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 356-4026.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the reason for the denial on this claim, [PII] states that durable medical equipment is not covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits from APO you can print it from our portal.
[AGENT][NEUTRAL] By going to [PII].
[CUSTOMER][POSITIVE] OK. All [PII]. Thank you so much for your help.
[AGENT][POSITIVE] OK. Well, you are certainly very welcome. And is there anything else, [PII], that I can help you with today?
[CUSTOMER][POSITIVE] That was all. Thank you.
[AGENT][POSITIVE] OK, well, you're certainly very welcome and thank you for calling APL. I hope you have a very nice rest of your day.
[CUSTOMER][NEUTRAL] You too. Uh-huh. Bye-bye.
[AGENT][POSITIVE] Thank you, bye bye.