AccountId: 011433970860
ContactId: 525c54c1-0e2e-4823-910a-184ed684c82b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 514890 ms
Total Talk Time (AGENT): 167404 ms
Total Talk Time (CUSTOMER): 173043 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/525c54c1-0e2e-4823-910a-184ed684c82b_20250422T18:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APO. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello. Could you able to hear me now?
[AGENT][NEUTRAL] Hi, I can hear you now.
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the office. This is gonna claim status.
[AGENT][NEUTRAL] OK, [PII], do you have a policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number I'm looking for is 025441110.
[AGENT][POSITIVE] OK, perfect. Thank you.
[CUSTOMER][NEUTRAL] In
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and then what's a good call back number in case our call gets dropped?
[CUSTOMER][NEUTRAL] Oh, callback number is [PII].
[CUSTOMER][NEUTRAL] [PII] and it's a direct line?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, perfect. And then what's the patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The patient's first name is [PII] and the last name is [PII], and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then do you have a data service and a charge amount?
[CUSTOMER][NEUTRAL] Yes, I'm looking for the date of [PII].
[CUSTOMER][NEUTRAL] [PII] for the total charge of amount of uh $2159 even that's $259.
[AGENT][POSITIVE] Perfect. And you said [PII]?
[CUSTOMER][NEUTRAL] Mm, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm just.
[CUSTOMER][NEUTRAL] And bro.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Sorry, just one moment. I'm trying to look for that claim number.
[CUSTOMER][NEUTRAL] Mm sure take it down.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so it looks like the received date is [PII]. The processed date is [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and this claim was denied.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, let's see, due to
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Benefits payable under this certificate are limited to those outlined on the schedule of benefits. This is a, this is not a covered loss under the plan. Therefore, no amount is payable for this expense.
[CUSTOMER][NEUTRAL] Yes, uh, upon checking with the stated that, uh, uh, it's there for the COV information and we'll send a letter to the patient for with the COV information, uh, with the, with the insurance. So we need to know whether the patient has responded for the letter or not.
[CUSTOMER][NEUTRAL] Have
[CUSTOMER][NEUTRAL] I think.
[AGENT][NEUTRAL] So it just looks like the, the benefits payable under the certificate are not limited to those outlined on the scheduled benefits. Um, whatever, what procedure they had done, it's just not covered under the loss under this plan.
[CUSTOMER][NEUTRAL] So the claim is denied as a non-covered benefits, that's right?
[AGENT][POSITIVE] Yes, sir, that is correct.
[AGENT][NEUTRAL] And I also have that claim number if you would like it.
[CUSTOMER][NEUTRAL] Mm yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It is 354.
[AGENT][NEUTRAL] 7441.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And may I know the reason for the non-covered?
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] May I know the reason for the non-COVID?
[CUSTOMER][NEUTRAL] Why the will is not covered on the member's plan, is there any specific reason?
[AGENT][NEGATIVE] It doesn't give me an exact reason. It just says that it is not covered under this policy.
[CUSTOMER][NEUTRAL] Uh, because we need the reason for the non-covered services in order to build the patient.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm. OK, so it says the reason is this is not a covered loss under the plan.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEGATIVE] Therefore, no amount is payable for this expense.
[CUSTOMER][NEUTRAL] And may I also get the pay plan, right?
[CUSTOMER][NEUTRAL] Let
[AGENT][NEUTRAL] Did you say the claim number?
[CUSTOMER][NEUTRAL] Uh, members plan type
[AGENT][NEUTRAL] Yes, just a second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah. Their plan type is Medli 6 policy.
[CUSTOMER][NEUTRAL] You can.
[CUSTOMER][NEUTRAL] It's kind of with you or if you.
[AGENT][NEUTRAL] Um, it just says that they have a Medlink 6 policy plan 2500.
[CUSTOMER][NEUTRAL] Oh, Ms. Could you put the policy name?
[AGENT][NEUTRAL] What was that?
[CUSTOMER][NEUTRAL] Uh, could you be the policy name for me?
[AGENT][NEUTRAL] Yes, it is Medlik 6 MED.
[AGENT][NEUTRAL] L I N K.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] 6.
[CUSTOMER][NEUTRAL] OK. 2500.
[CUSTOMER][NEUTRAL] And could you able to fax me the copy of your?
[AGENT][POSITIVE] Yes, of course, I can do that for you.
[AGENT][NEUTRAL] Uh, what is your fax number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] 999-4535 with attention to my name, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Perfect. And I can do that for you. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] Mm, that is for me, and thank, uh, could you spell your name for me in the English purpose?
[AGENT][NEUTRAL] Yes, of course. It's [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm mhm. And uh can I get the reference number for our call?
[AGENT][NEUTRAL] Yes, so it's my first name, [PII], last initial [PII], and then today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you for the information and that's all the information I need today. Thanks for asking me. Have a great day.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, thank you, [PII]. Thanks for calling APL. Have a good day. Mhm. All right, bye.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm bye for now.