AccountId: 011433970860
ContactId: 4ce24b83-d576-41c2-8615-9dc890681900
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 272679 ms
Total Talk Time (AGENT): 134774 ms
Total Talk Time (CUSTOMER): 43913 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/4ce24b83-d576-41c2-8615-9dc890681900_20250408T15:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling to get claim status please.
[AGENT][NEUTRAL] OK [PII], you're needing claim status for a member, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes ma'am, I can help you with that. And [PII], what is a good call back number for you?
[CUSTOMER][NEUTRAL] OK, it's myself and now I'm working from home. It's [PII].
[AGENT][NEUTRAL] OK, thank you. And how many claims do you have [PII] to check status on?
[CUSTOMER][NEUTRAL] Only have one.
[AGENT][NEUTRAL] OK, and what is that member's policy number, please?
[CUSTOMER][NEUTRAL] OK, what I have here is 02510235.
[AGENT][POSITIVE] Thank you. Give me a couple of moments, please, [PII] to get the member's information pulled up.
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] I'm learning the information that I do provide for you today 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] OK, I have [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount for her place?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII] and the bill amount is for $460.
[AGENT][NEUTRAL] 460. Is that correct?
[CUSTOMER][NEUTRAL] 460 correct.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] OK, so are you needing the original claims information because this claim has been received multiple times that have been denied as duplicates. So are you needing the initial claims information?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so the original claim was received [PII].
[AGENT][NEGATIVE] It was processed and denied.
[AGENT][NEUTRAL] On
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The claim number is 351.
[AGENT][NEUTRAL] 7359
[AGENT][NEUTRAL] And again, as I stated, this claim was denied. The denial remark on code 99385.
[AGENT][NEUTRAL] States the calendar year maximum for wellness benefit has been met for this calendar year.
[AGENT][NEGATIVE] And the code 36415 was denied stating venna puncture is not covered by this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now if you need a copy of this explanation of benefits for, you should be able to print that now that you have the claim number.
[AGENT][NEUTRAL] By going to our portal.
[AGENT][NEUTRAL] And our portal website is secured. [PII].
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][POSITIVE] Well, you are certainly very welcome. Is there anything else that I can help you with this morning?
[CUSTOMER][NEUTRAL] Yes, the reference number please.
[AGENT][POSITIVE] Yes, ma'am, you would use my name I gave you along with today's date.
[CUSTOMER][POSITIVE] Alright [PII] thank you again.
[AGENT][POSITIVE] OK. Well, you're welcome and thank you for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][POSITIVE] Thank you, bye bye.