AccountId: 011433970860
ContactId: 4b9b31f8-8bc3-4b41-b92e-5f13cca50d3c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 275390 ms
Total Talk Time (AGENT): 101396 ms
Total Talk Time (CUSTOMER): 81461 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/4b9b31f8-8bc3-4b41-b92e-5f13cca50d3c_20250115T14:22_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from private office, and I'm looking for claim status.
[AGENT][POSITIVE] Sure, ma'am, I can assist you with that. I have a callback number for you and that policy number.
[CUSTOMER][NEUTRAL] [PII] [PII]. And the policy number is 01835781.
[AGENT][NEUTRAL] Thank you, [PII]. Could you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, patient name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] And you're calling to check the status of a claim for medical?
[CUSTOMER][NEUTRAL] Medical.
[AGENT][NEUTRAL] What is the date of service?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[AGENT][NEUTRAL] And what is your bill amount?
[CUSTOMER][NEUTRAL] The amount is $6200 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Do you have a procedure code?
[CUSTOMER][NEUTRAL] Yeah, it is 453-85 and 45,380.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This claim was received [PII]. It was processed [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] There was no payment made on this claim?
[AGENT][NEGATIVE] And the reason why there was no payment made on this claim is because wellness, wellness screening not covered on this policy. This policy does not provide wellness benefits.
[CUSTOMER][NEUTRAL] OK, so this, these services that we build are not covered under this member plan.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] Can you please provide me which plan type does member have?
[AGENT][NEUTRAL] This is a hospital indemnity policy.
[CUSTOMER][NEUTRAL] Hospital and the medical policy.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Just wait a second.
[CUSTOMER][NEUTRAL] But as I check, percentage is 55 years and the services that we build are covered under this plan.
[AGENT][NEUTRAL] Yes that is correct. The the policy does not cover services provided. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] OK, just wait a second.
[CUSTOMER][NEUTRAL] OK. Can you please provide me your mailing address?
[AGENT][NEUTRAL] The mailing address will be the same as the claims address, however, I can provide you with that information.
[CUSTOMER][NEUTRAL] And what is the time limit?
[AGENT][NEUTRAL] It's gonna be
[AGENT][NEUTRAL] There's no timely filing. It's gonna be addressed to APL claims department.
[AGENT][NEUTRAL] [PII]. That's [PII].
[AGENT][NEUTRAL] [PII]. That's [PII].
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] OK. OK, thank you, I'm done.
[CUSTOMER][NEUTRAL] Can you please also provide me the claim number?
[AGENT][NEUTRAL] 3,531,040
[CUSTOMER][NEUTRAL] OK. And the call reference number?
[AGENT][NEUTRAL] We don't provide those, [PII]. However, you can use my name in today's date as a reference. My name is [PII], and today's date.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] And can you please, mhm. OK. And can you please fax the denial will be on our fax.
[AGENT][NEUTRAL] What is your fax number?
[CUSTOMER][NEUTRAL] It is 855.
[CUSTOMER][NEUTRAL] 632
[CUSTOMER][NEUTRAL] 2489.
[AGENT][NEUTRAL] I have [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] No, and how much time it will take to receive?
[AGENT][NEUTRAL] I'm not sure, however, I can send it over for you.
[CUSTOMER][POSITIVE] OK. OK, thank you.
[AGENT][POSITIVE] You're welcome, thanks for calling APL and have a great day, [PII].
[CUSTOMER][NEUTRAL] Bye-bye.