AccountId: 011433970860
ContactId: 4abb5996-8593-49d0-bd4d-cb8329b3e295
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 316179 ms
Total Talk Time (AGENT): 109653 ms
Total Talk Time (CUSTOMER): 83152 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/4abb5996-8593-49d0-bd4d-cb8329b3e295_20250521T15:21_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling you regarding a claim.
[AGENT][NEUTRAL] OK, I can verify claim status for you, [PII], and what is the policy number, please?
[CUSTOMER][NEUTRAL] That's 01897867.
[AGENT][NEUTRAL] Thank you. Give me one moment, please. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure. That's [PII].
[AGENT][NEUTRAL] OK, thank you. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you. And what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] That's [PII] with the charged amount of $70,310 even.
[AGENT][NEUTRAL] OK, thank you. And do you have the balance after primary has processed the claim?
[CUSTOMER][NEUTRAL] Yeah, that's $75 even.
[AGENT][POSITIVE] Thank you, give me one moment.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK. And you're calling from?
[CUSTOMER][NEUTRAL] I'm calling from ophthalmological.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] I'm sorry, what's the name of the provider's office it cut out?
[CUSTOMER][NEUTRAL] That's ophthalmology consultant.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, uh, show that claim processed as office visits are not covered on the policy, and for the other charge, the primary paid in full, so there's no benefits payable.
[CUSTOMER][NEUTRAL] OK, so you have
[CUSTOMER][NEGATIVE] Denied this claim.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Because the office visit is not covered in patients benefit plan.
[AGENT][NEUTRAL] Correct. Per the patient's policy, office visits are not covered.
[CUSTOMER][NEUTRAL] OK. Just a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. Thank you. And when did you receive the claim?
[AGENT][NEUTRAL] Uh, the claim was received [PII] of this year.
[CUSTOMER][NEUTRAL] And processed
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Claim number, please?
[AGENT][NEUTRAL] 35897002.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you very much.
[CUSTOMER][NEUTRAL] So, can you please fax the EV of this one?
[AGENT][NEUTRAL] Sure. And also just to 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] Mhm.
[AGENT][NEUTRAL] And Ms. [PII], what is the fax number?
[CUSTOMER][NEUTRAL] The fax number is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and that's [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, how much time will it take to receive the UV?
[AGENT][POSITIVE] Hopefully in a few moments.
[CUSTOMER][POSITIVE] OK. Thank you very much. Can you please spell your name as well?
[AGENT][NEUTRAL] Sure, it's [PII]. And Ms. [PII], is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Call reference, please.
[AGENT][NEUTRAL] Uh, if you, um, you can use my name at today's date as call reference.
[CUSTOMER][POSITIVE] OK. Thank you very much, ma'am, for this one. Have a great day ahead.
[AGENT][POSITIVE] Oh, you're welcome. Thank you for calling APL. Have a great day. Bye.