AccountId: 011433970860
ContactId: 49727972-0d40-4a9a-8efe-a3e9cdd03ef2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 377459 ms
Total Talk Time (AGENT): 146454 ms
Total Talk Time (CUSTOMER): 116986 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/49727972-0d40-4a9a-8efe-a3e9cdd03ef2_20250124T22:05_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] Hey [PII], my name's [PII]. I'm calling from an agent's office and I just needed to check on some claims from a couple of years ago.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the claims. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] Thank you for that. And then may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 229-09000.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I just need you to verify um your email address and then the agent, the company name.
[CUSTOMER][NEUTRAL] OK, so my email address is [PII] and the agent is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And hold on one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] 5782.
[AGENT][NEUTRAL] OK, here we go. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] So the first one is [PII].
[AGENT][NEUTRAL] And the total bills?
[CUSTOMER][NEUTRAL] $311.05.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] $311.05.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 123, so I'm gonna just do it like this.
[AGENT][NEUTRAL] There were a few claims that were processed that day, the way they had like the lines are like a penny, a penny, a penny. So I'm trying to go through them. Hold on one second.
[CUSTOMER][NEUTRAL] Oh Lord.
[AGENT][NEUTRAL] 341-307. OK, so it looks like these, did I miss any?
[AGENT][NEUTRAL] 76525.
[AGENT][NEUTRAL] 18 OK.
[AGENT][NEUTRAL] So I believe I got them all. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 418.
[AGENT][NEUTRAL] OK, here we go. So the very first claim.
[AGENT][NEUTRAL] was received on
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that claim number is 331.
[AGENT][NEUTRAL] 341 8.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Um, as office visits are not covered on this policy.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got that one. Let me see because I've got like 5 dates of service for the same girl. Is it easier if I give you the claim numbers that I have?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Or is the data service easier?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] No, the claim number is better, and then like you're just wanting like the day it was received and processed and then the reasoning.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For, OK.
[CUSTOMER][NEGATIVE] Yeah, really just the reasoning. I don't even need when it was received.
[AGENT][NEUTRAL] OK, um, well, yes, ma'am, the policy, I'm sorry, I said the policy, the claim number is fine, my apologies.
[CUSTOMER][NEUTRAL] That's OK. OK, so that same date of service I have a claim number 34130007.
[AGENT][NEUTRAL] OK, so that was one of the ones I wrote down. Hold on one moment. 007. That was denied as a duplicate.
[CUSTOMER][NEUTRAL] OK, got it. My next one claim number 3410762, that was [PII].
[AGENT][NEUTRAL] 3410762. OK, and that one was also denied because office visits are not covered on the policy.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Next.
[CUSTOMER][NEUTRAL] 341-482-0
[AGENT][NEGATIVE] Um, this was denied as a duplicate.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And let's see 3405218.
[AGENT][NEUTRAL] 218
[AGENT][NEUTRAL] 340.
[CUSTOMER][NEUTRAL] It was [PII].
[AGENT][NEUTRAL] OK, here it is. That one was denied as a duplicate as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And my last 1 [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Now, this one was denied requesting the explanation of benefits from primary insurance.
[CUSTOMER][POSITIVE] All right, got it. OK, I think that's all that I need I appreciate your help.
[AGENT][POSITIVE] Well, you're very welcome and thanks for calling APL. I hope you have a great weekend.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.