AccountId: 011433970860
ContactId: 4af876a5-8ca8-4b56-9654-791354aa7e04
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 168240 ms
Total Talk Time (AGENT): 61921 ms
Total Talk Time (CUSTOMER): 60426 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/4af876a5-8ca8-4b56-9654-791354aa7e04_20250317T19:56_UTC.wav
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[AGENT][NEUTRAL] For calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from the provider office and this call is regarding claim status.
[AGENT][POSITIVE] I'd be happy to assist with claim status today [PII] if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Callback number is [PII]. And it's a direct line?
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] 02464411.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII].
[CUSTOMER][NEUTRAL] And the last name is, uh, I mean, the first name is [PII] and the last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Um, can I have that policy number again? That's not matching what you're telling me.
[CUSTOMER][NEUTRAL] 024 02464411.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And are you calling for inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] Uh, it's outpatient.
[AGENT][NEUTRAL] I do show the outpatient calendar year maximum is $4000.
[CUSTOMER][NEUTRAL] Um, I need the claim status.
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] Uh, data service is [PII].
[AGENT][NEUTRAL] And your tax ID?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. I'm showing the claim denied because office visits, the, yeah, the copay.
[AGENT][NEUTRAL] With associated with the office visit is not covered.
[CUSTOMER][NEUTRAL] So the second, uh, so the primary insurance co-pay is not covered under the plan, right? So this is patient responsibility, correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Understood. No worries. Thank you so much for this information, and that's it for before that, could you just help me the claim number and the car reference number?
[AGENT][NEUTRAL] Claim number is 3555594. Reference is just my name [PII], last [PII] [PII], and the date and time of the call.
[CUSTOMER][POSITIVE] Thank you, [PII]. That's it for today. Bye for now.
[AGENT][POSITIVE] Thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] Mhm.