AccountId: 011433970860
ContactId: 483765af-c721-4b75-8e6f-33b0c38638ac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 293429 ms
Total Talk Time (AGENT): 75599 ms
Total Talk Time (CUSTOMER): 104839 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/483765af-c721-4b75-8e6f-33b0c38638ac_20250428T14:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from Elite Eye Care. I need claim status on a patient.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] I do. I have.
[CUSTOMER][NEUTRAL] 153494.
[CUSTOMER][NEUTRAL] 1
[CUSTOMER][NEUTRAL] The letter M as in Mary, L as in Larry, and the number 8.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] And uh uh date of service?
[CUSTOMER][NEUTRAL] Um, the first date of service I have is 10-7-2024.
[AGENT][NEUTRAL] Uh, it looks like this policy term 41-2023. Let me see if he's got a more policy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what was that data service again? Sorry about that.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] Uh 10 7 2024.
[AGENT][NEUTRAL] Um, I don't show a claim on file.
[CUSTOMER][NEUTRAL] Do I have the right
[CUSTOMER][NEUTRAL] ID or is it a different one?
[AGENT][NEUTRAL] Yeah, the policy, which we would still look and see if there was an active policy, but let me give you that policy number um to refile. That policy number is 233.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 1179.
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 233-1179
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Yeah, we, we filed it on, we filed it twice. We filed it in [PII].
[CUSTOMER][NEUTRAL] And then [PII].
[AGENT][NEUTRAL] You know what address you filed it to or did you fax it or?
[CUSTOMER][NEUTRAL] Um, so you know where it is. Actually, it was, it was mailed, and let me look at the claim.
[CUSTOMER][NEUTRAL] I'm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh, yes, that's correct. [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Is there a fax number I can fax these?
[AGENT][NEUTRAL] Yeah, absolutely. It's 877-365.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How about um [PII] uh date of service [PII].
[AGENT][NEUTRAL] And [PII] is the patient, correct?
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] Uh, what was the bill charges on that?
[CUSTOMER][NEUTRAL] $259259.
[AGENT][NEUTRAL] OK, it looks like we did get that one. Let me see what.
[AGENT][NEUTRAL] Process.
[AGENT][NEUTRAL] 2
[AGENT][NEGATIVE] Um, that one was denied. Office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] So he doesn't have co-payment coverage?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEGATIVE] So there's no point on submitting the other ones, yeah, because these were submitted for co-payments.
[AGENT][NEUTRAL] OK, yeah, the plan actually does not cover office visits themselves.
[CUSTOMER][POSITIVE] OK. All right. Perfect. That'll do it.
[CUSTOMER][POSITIVE] Well, thank you so much for your help.
[AGENT][POSITIVE] Hi, thank you for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too. Bye bye.