AccountId: 011433970860
ContactId: 4a1b2a62-72bb-49e1-8fbb-e504ae587cb9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 260619 ms
Total Talk Time (AGENT): 101180 ms
Total Talk Time (CUSTOMER): 131232 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/4a1b2a62-72bb-49e1-8fbb-e504ae587cb9_20250227T19:48_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm here to check on and claim status today. Could you please tell me your name again?
[AGENT][NEUTRAL] Sure, it's [PII], last name, and you say your name is [PII]?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what is that policy number, please?
[CUSTOMER][NEUTRAL] Yes, the member's policy number is 02512377.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Data services [PII] for the total charges of $26 even.
[AGENT][NEUTRAL] You said a date of service [PII]?
[CUSTOMER][NEUTRAL] Yes, for $26 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. And while I'm looking up claim information, let you know we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII].
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Bye
[AGENT][NEUTRAL] And you're calling from?
[CUSTOMER][NEUTRAL] Calling from Norton Community Medical Associates.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't.
[AGENT][NEUTRAL] OK one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, show that the claim process as viny puncture is not covered uh per the policy.
[CUSTOMER][NEUTRAL] OK, we need puncture is not covered under the policy. So the total charges is going to be the members, uh, the total charge is going to be responsibility, right?
[AGENT][NEUTRAL] Uh, well, I can't give patient responsibility. I can only verify how the claim was processed and that process is not covered.
[CUSTOMER][NEUTRAL] OK, it is no good for the same member there is another claim. So could you please assist me with that?
[AGENT][NEUTRAL] Uh, what was that data service and amount of the charge?
[CUSTOMER][NEUTRAL] Data service is [PII] for the total charges of $99 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh let me see.
[CUSTOMER][POSITIVE] And I am at 123 password. How to download funny on this upload funny.
[AGENT][NEUTRAL] I'm showing the claim process as this policy does not provide a wellness expense benefit.
[CUSTOMER][NEUTRAL] This is
[CUSTOMER][NEUTRAL] OK, it does not wellness, right?
[AGENT][NEUTRAL] Correct. This policy does not provide a wellness expense benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The total charges are non-cover, right?
[AGENT][NEUTRAL] Correct, it's not covered per the policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So could you for this also uh the members responsible, right?
[AGENT][NEUTRAL] As I stated previously, we cannot give patient responsibility. We can only verify how the claim was processed.
[CUSTOMER][NEUTRAL] OK, so could you please provide me the call reference number?
[AGENT][NEUTRAL] We don't give reference numbers. If you like, you may use my name in today's date. And TJ, is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, thank you for assisting me today. Have a nice day.