AccountId: 011433970860
ContactId: 4b1a2805-c412-4b94-b355-8652ae4c7f0f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 366540 ms
Total Talk Time (AGENT): 168388 ms
Total Talk Time (CUSTOMER): 70415 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/4b1a2805-c412-4b94-b355-8652ae4c7f0f_20250212T16:18_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from Pros office checking on a claim status.
[AGENT][NEUTRAL] I'm sorry, what was your name again?
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] OK, thank you, and [PII], you have one claim to check claim status on, is that correct?
[CUSTOMER][NEUTRAL] Oh, yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is a good callback number for you please?
[CUSTOMER][NEUTRAL] The callback number is [PII] along with extension [PII].
[AGENT][NEUTRAL] OK, thank you and the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] Yes, the policy number is 016.
[CUSTOMER][NEUTRAL] 999
[CUSTOMER][NEUTRAL] 61 M as in Mike, L as in Lima 7.
[AGENT][NEUTRAL] OK, thank you. One moment please.
[AGENT][NEUTRAL] OK, and any information [PII] that I provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the patient's name is.
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] With the date of birth [PII].
[AGENT][NEUTRAL] Thank you. And the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Yes, the date of services [PII] with the bill amount $312 even.
[AGENT][POSITIVE] Thank you one moment please.
[AGENT][NEUTRAL] OK, so there is no claim on file for this member on this policy again you said that the.
[AGENT][NEUTRAL] Service date [PII]. That is correct.
[CUSTOMER][NEUTRAL] So there's no claim on form.
[CUSTOMER][NEUTRAL] OK. Uh.
[AGENT][NEUTRAL] And this policy actually has a term date of [PII].
[CUSTOMER][NEUTRAL] May I know the uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm. And then within the policy was effective for [PII] and termed for [PII], and there's no other active coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry, there, there was another policy that was active from [PII]. Give me a moment to see if by chance it was processed under that claim, a different claim number, I mean a different policy number rather. So one moment, please.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, so we did process it under the correct policy number. The policy number you should have for this number is 02473136.
[AGENT][NEUTRAL] This policy was active from [PII].
[AGENT][NEUTRAL] To 61-2024.
[AGENT][NEUTRAL] And this claim was received on [PII], processed on [PII].
[AGENT][NEUTRAL] The claim number
[AGENT][NEUTRAL] It's 352.
[AGENT][NEUTRAL] 8961.
[AGENT][NEUTRAL] And this claim was denied. The reason for the denial on the claim, [PII] states kinesiology, speech, or occupational therapy are not covered under this policy. The members plan.
[AGENT][NEGATIVE] Does not cover this.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, may I know for which dollar amount it is, uh, bill the claim? What is the dollar amount for that?
[AGENT][NEUTRAL] OK, this is a supplemental policy. We are not a major medical insurance carrier.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Uh, uh, could you please spell out your name?
[AGENT][NEUTRAL] [PII] and my name along with today's date would be your call reference number. And if you need a copy of this explanation of benefits, [PII], you can print that by going to our portal at [PII].
[CUSTOMER][POSITIVE] Thank you, uh, [PII] for answering all my queries. Have a great day.
[AGENT][POSITIVE] Well, you're very welcome. I hope you have a great day too, and thank you again for calling APL.
[CUSTOMER][POSITIVE] Thank you for
[AGENT][POSITIVE] You're welcome. Bye bye.