AccountId: 011433970860
ContactId: 5674ab8d-4200-45a7-82f1-18c7d611da9c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 343290 ms
Total Talk Time (AGENT): 100787 ms
Total Talk Time (CUSTOMER): 108893 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/5674ab8d-4200-45a7-82f1-18c7d611da9c_20250404T17:09_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. Very good afternoon. This is [PII] calling from products office to check on the claim status.
[AGENT][NEUTRAL] I'm sorry, can you repeat your name for me, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And [PII], if I can get a good callback number for you?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Sure, callback number is [PII] direct line.
[AGENT][POSITIVE] OK, I'll be happy to assist with claim status. May I have that policy number please?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Mm, pulling out your policy number, it is uh D as in Delta 43301881.
[AGENT][NEUTRAL] OK, that's not a dental number, that's their wellness number. Do you have a social?
[CUSTOMER][NEUTRAL] Sure, sure, I don't have, I think so.
[AGENT][NEUTRAL] What's the patient's name?
[CUSTOMER][NEUTRAL] I have only last 4 of social.
[CUSTOMER][NEUTRAL] Uh, last four of social is fine.
[AGENT][NEUTRAL] No, uh, if you don't have the whole social, I can't use it. Can I have their name?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Do you have an address for her?
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's the date of service for the claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. I'm not showing we have that claim on file.
[CUSTOMER][NEUTRAL] we have
[CUSTOMER][NEUTRAL] Uh, uh, uh, we have been connected to the coding team as well, uh, like, uh.
[CUSTOMER][NEUTRAL] Let's see
[AGENT][NEUTRAL] Oh, now was, I'm sorry, was this for medical or dental?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Medical. I'm sorry. I'm sorry. I'm gonna do the dental. One moment.
[CUSTOMER][POSITIVE] No problem. Spell out your name for me.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you said that data service was in March, March, I'm sorry, what was the data service again, please?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's your tax ID?
[CUSTOMER][NEUTRAL] Pulling out
[CUSTOMER][NEUTRAL] Tax ID is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you for that information. One moment.
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] OK, I'm showing that claim denied because it's not a covered um testing.
[AGENT][NEUTRAL] Under the policy.
[CUSTOMER][NEUTRAL] Uh, can you please give me the brief information about that?
[AGENT][NEGATIVE] I don't understand.
[CUSTOMER][NEUTRAL] Uh, can you please tell me the complete, uh, why the claim is not covered?
[AGENT][NEUTRAL] Claim is not covered because that's not a covered diagnostic test under her policy.
[AGENT][NEUTRAL] The only tests that are covered are MRIs, CT scans, and colonoscopies. That's it.
[CUSTOMER][NEUTRAL] that are
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Mm, was performed previous setting, diagnosis quotes are not covered. Uh, you mean to say that diagnosis quotes are not covered as per uh patient plan?
[AGENT][NEUTRAL] Not the diagnosis, the procedure code. The procedure that she had is not a covered procedure under her policy.
[CUSTOMER][NEUTRAL] Help me with the procedure code which you have.
[AGENT][NEUTRAL] You don't know what you build?
[CUSTOMER][NEUTRAL] We will, I just want a clarification from your end too.
[AGENT][NEUTRAL] Oh, OK, um,
[AGENT][NEUTRAL] It just says diagnosis, diagnostic. It doesn't say, I don't have the code.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Was it a, did you bill for an MRI, a CT or a colonoscopy?
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] OK, so those are the only 3 that are covered under her plan. Anything else is not covered?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, give me a minute, I'll check for the information.
[CUSTOMER][POSITIVE] Thank you so much for this information. Do you have a reference number?
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII] [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] That's.
[CUSTOMER][POSITIVE] Thank you. Uh, nothing else. Thank you.
[AGENT][POSITIVE] Thank you for calling APL you have a good day.
[CUSTOMER][POSITIVE] Take care bye.
[AGENT][NEUTRAL] Right.