AccountId: 011433970860
ContactId: 4c9cd974-adb7-4b74-a67d-07a183381786
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 447380 ms
Total Talk Time (AGENT): 177981 ms
Total Talk Time (CUSTOMER): 96950 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/4c9cd974-adb7-4b74-a67d-07a183381786_20250505T18:10_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check on a claim.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status on one claim, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, please, [PII].
[CUSTOMER][POSITIVE] Uh, yes, let me help you with that.
[CUSTOMER][NEUTRAL] It is 206-599-97.
[AGENT][NEUTRAL] Thank you one moment while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I'm.
[AGENT][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And any information that I do provide for you, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] Yeah, it is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, so I must have misheard what you said that the policy number was. Can you give me the policy number again, please?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, it is 206-599-997.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And again your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it is. Date of birth is [PII].
[AGENT][NEUTRAL] What's the last name?
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[AGENT][NEUTRAL] Bro, OK.
[AGENT][NEUTRAL] OK one moment.
[AGENT][NEUTRAL] And again, any information provided will be a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Data services [PII] with the total charge amount of $205 even.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] OK, so first off, you have a policy number that's not accurate. The correct policy number that you should have is different. It should be 251.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 5492.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] With an effective date of [PII].
[CUSTOMER][NEUTRAL] Can you please come again?
[AGENT][NEUTRAL] 02.
[CUSTOMER][NEUTRAL] Sorry, it is 25.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me start from the beginning.
[CUSTOMER][NEUTRAL] Yeah, what is your member ID?
[AGENT][NEUTRAL] 02515492.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is the effective date?
[AGENT][NEUTRAL] [PII] and that policy is active with no termination date.
[AGENT][NEUTRAL] But give me just a moment to get that correct information pulled up please.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] 7.
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Is there any claim on file for that data service?
[AGENT][NEUTRAL] One moment and I'm because I had to pull up a different policy since you have an incorrect policy number. So just a moment, please.
[AGENT][NEUTRAL] OK, so this claim was received.
[AGENT][NEUTRAL] The claim was received on [PII]. It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Just give me a second.
[CUSTOMER][NEUTRAL] Just give me a second. Claim is receipt on.
[AGENT][NEUTRAL] [PII] denied [PII], excuse me, 24. Received 23, denied on [PII].
[AGENT][NEUTRAL] The claim number is 355.
[CUSTOMER][NEUTRAL] OK, the night.
[AGENT][NEUTRAL] 9380.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEGATIVE] And it was denied because office visits are not covered under this supplemental policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just give me a second.
[CUSTOMER][NEUTRAL] Claim number
[AGENT][NEUTRAL] The members
[CUSTOMER][NEUTRAL] Uh, date of denial is also the same, right? [PII].
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Is it 2025, right?
[AGENT][NEUTRAL] 2025, yes ma'am.
[AGENT][NEUTRAL] Your data services in [PII]. This was received.
[CUSTOMER][NEUTRAL] Denied
[AGENT][NEUTRAL] [PII] and it was denied on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Who is responsible for that amount?
[AGENT][NEUTRAL] I'm sorry, [PII], I didn't understand what you said.
[CUSTOMER][NEUTRAL] Who is responsible for that amount?
[AGENT][NEUTRAL] I, I, I can't hear you.
[CUSTOMER][NEUTRAL] Who is responsible for the remaining balance of $75?
[AGENT][NEUTRAL] Office visits are not covered under this supplemental policy.
[CUSTOMER][POSITIVE] Uh, yup, thank you so much. Have a nice day.
[AGENT][NEUTRAL] You're welcome. And if you need a copy of that explanation of benefits with a remark on there, you may print that by going to our portal and using that claim number, and our portal website is located at [PII].
[CUSTOMER][POSITIVE] Yeah, thank you so much. Have a nice day.
[AGENT][POSITIVE] You're welcome, [PII]. Well, you too, if that's all I can help you with. Thank you again for calling APL.