AccountId: 011433970860
ContactId: 4a4d5e3b-df53-424a-8cb8-4df01349a18a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 200029 ms
Total Talk Time (AGENT): 51285 ms
Total Talk Time (CUSTOMER): 62918 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/4a4d5e3b-df53-424a-8cb8-4df01349a18a_20250122T15:39_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office. I would like to check that in our recent.
[AGENT][NEUTRAL] I can help you, [PII], what's the policy number?
[CUSTOMER][NEUTRAL] Policy number 018521.
[CUSTOMER][NEUTRAL] 27
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] My number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The extension [PII].
[AGENT][NEUTRAL] Thank you. Do you have the claim number?
[CUSTOMER][NEUTRAL] Yes, I have the claim number.
[CUSTOMER][NEUTRAL] Just a second, let me take a look.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Claim number 354.
[CUSTOMER][NEUTRAL] 7370.
[AGENT][NEUTRAL] OK, give me one moment to pull up the file, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the patient's name and date of birth, [PII]?
[CUSTOMER][NEUTRAL] patient's name.
[CUSTOMER][NEUTRAL] [PII] and date of birth on [PII].
[AGENT][NEUTRAL] Alright, and you said that you're calling to verify that the denial of claim 354-7370?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] On the back of the explanation, it should say that office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. So it is as per the member's plan, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] It is not covered as per member's plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so can I have patient plan name and plan type?
[AGENT][NEUTRAL] The Metlink policy.
[AGENT][NEUTRAL] And I'm not sure what you mean by plan type.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Is that the HMO or BPO?
[AGENT][NEUTRAL] It's a Metlink policy. It's like a supplemental policy to the major medical plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. Can I have the call reference number?
[AGENT][NEUTRAL] OK. Any other?
[AGENT][NEUTRAL] Uh-huh. You'll use my name in today's date. [PII]
[AGENT][NEUTRAL] First initial of my last name is [PII]. And any further questions there I can help out with today?
[CUSTOMER][POSITIVE] And I'm done with this. Thank you so much for your time.
[AGENT][POSITIVE] Oh, you're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Same to you bye bye.
[AGENT][NEUTRAL] Bye bye.