AccountId: 011433970860
ContactId: 4de2b79a-14ca-4d85-b94b-1fb4b7031af5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 540489 ms
Total Talk Time (AGENT): 152464 ms
Total Talk Time (CUSTOMER): 109253 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/4de2b79a-14ca-4d85-b94b-1fb4b7031af5_20250407T18:44_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, hi, [PII]. My name is [PII], uh, calling from provider's office to check on claim status. How are you doing today?
[AGENT][POSITIVE] I'm doing well, [PII]. How are you?
[CUSTOMER][POSITIVE] Yeah, I'm also good. Thank you for asking.
[AGENT][POSITIVE] That's good, and I'll be more than happy to help you with your claims. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Only one claim.
[AGENT][NEUTRAL] Alright, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] so
[CUSTOMER][NEUTRAL] 183
[CUSTOMER][NEUTRAL] 8929
[AGENT][NEUTRAL] 183-892-9
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] OK. It's uh first name is [PII]. And date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you want me to check on?
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII].
[AGENT][POSITIVE] Thank you for that and the total bills.
[CUSTOMER][NEUTRAL] Uh, $339 even.
[AGENT][NEUTRAL] Thank you. Hold on one and do you mind if I place you on just a brief hold while I locate the claim for you?
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 7969796. What's the 1st 124?
[AGENT][NEUTRAL] 0, 67. OK, I'm like, I don't see it anywhere.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, and what about this one?
[AGENT][NEUTRAL] 715.
[AGENT][NEUTRAL] Are the same DM 019.
[AGENT][NEUTRAL] OK, wait a minute. 334.
[AGENT][NEUTRAL] OK, it's the same code.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yeah, tell me.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So we received the claim twice. Did you need the original claim or the second claim that we received? They were denied for the same reason.
[CUSTOMER][NEUTRAL] One minute.
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, so, firstly, please provide the original claim when it is received and denied and why it's denied.
[AGENT][NEUTRAL] OK, so you need the original claim, that was my question. So you want the original claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. So we received the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 334.
[CUSTOMER][NEUTRAL] D
[AGENT][NEUTRAL] 7967.
[AGENT][NEUTRAL] And on [PII].
[CUSTOMER][NEUTRAL] OK. Uh, when it is delivered?
[AGENT][NEUTRAL] I'm going to give you all the information. On [PII], the claim was denied.
[AGENT][NEUTRAL] Because the the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEGATIVE] Service is not covered. Uh
[AGENT][NEUTRAL] When performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] When perform on doctor's office.
[CUSTOMER][NEUTRAL] OK. Why it is not covered?
[AGENT][NEGATIVE] It's not covered by the patient's policy. It doesn't cover office visit settings.
[CUSTOMER][NEUTRAL] Patient's policy, OK. Uh, it doesn't cover office visits, correct, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. Uh, this is the claim number. I got it. OK.
[CUSTOMER][NEUTRAL] OK. Could you please provide the second claim details?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] When, OK, when it is received and denied.
[AGENT][NEUTRAL] Yes, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I received that um the second claim on [PII].
[AGENT][NEUTRAL] The claim number is 357.
[AGENT][NEUTRAL] 8715.
[CUSTOMER][NEUTRAL] OK. 357-871-5, right?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And on [PII], the claim was denied for the same reason.
[AGENT][NEUTRAL] Not covered in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh, OK. Um, uh, oh, [PII], just could you please hold for a moment?
[AGENT][NEUTRAL] Hm, sure.
[CUSTOMER][POSITIVE] Yeah, OK. Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK. Thank you enough for being on hold. Thank you so much. And uh OK. Could you please provide the call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK. OK. Your first name and today's date, right?
[AGENT][NEUTRAL] Yes, my first name is [PII]
[CUSTOMER][POSITIVE] OK. OK. OK. Thank you so much for giving this information. Have a great day.
[AGENT][POSITIVE] You're very welcome, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Uh no, nothing. That's it. Thank you. Thank you so much.
[AGENT][POSITIVE] Alright, thanks for calling APL. You're welcome. Bye-bye.
[CUSTOMER][POSITIVE] Have a good.