AccountId: 011433970860
ContactId: 5aa01ea1-e5f7-4b87-b26e-9327375967f6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1150849 ms
Total Talk Time (AGENT): 248676 ms
Total Talk Time (CUSTOMER): 190407 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/5aa01ea1-e5f7-4b87-b26e-9327375967f6_20250616T12:41_UTC.wav
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[AGENT][POSITIVE] And thank you for calling. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from the doctor's office to check on a claim status.
[AGENT][POSITIVE] Alright, I'll be glad to help you. Go ahead and give me your policy number, please.
[CUSTOMER][NEUTRAL] The Member policy number is 02320071.
[AGENT][NEUTRAL] Alrighty Lola, thank you for that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number, please.
[CUSTOMER][NEUTRAL] Our callback number is [PII]. And the extension is [PII].
[AGENT][NEUTRAL] Alrighty, Lola. Thank you for that information. Now your patient's name and date of birth, please sir.
[CUSTOMER][NEUTRAL] The patient's name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Alrighty, Lola, thank you for that information. Looks like [PII] is the insured on this medical supplemental plan, and you did say you want to check status of a claim.
[AGENT][NEUTRAL] Is that correct, Lola?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Uh, we're looking for the data services [PII].
[CUSTOMER][NEUTRAL] And the charge amount is $288.
[AGENT][NEUTRAL] OK,
[AGENT][NEUTRAL] OK, Lola, I, uh, your phone is really static and I did not get that data service. Can you repeat that, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII]. Alrighty, give me just a second. Let's see. Alright, I see a bill.
[AGENT][NEUTRAL] For that day, the service, let's see if this is it.
[AGENT][NEUTRAL] Yeah, 350, uh, how much did you say your bill was for total?
[CUSTOMER][NEUTRAL] $288 even.
[AGENT][NEUTRAL] OK, 288. I do see that claim in-house and it is for an office visit. Office visits are not covered under this plan.
[CUSTOMER][NEUTRAL] It is not covered under the patient's plan or provides plan.
[AGENT][NEUTRAL] That's correct. It's not covered under patient plan.
[CUSTOMER][NEUTRAL] Can you please provide the
[CUSTOMER][NEUTRAL] Can you please spell out your name?
[AGENT][NEUTRAL] Uh, I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] Can you please spell out your name?
[AGENT][NEUTRAL] I sure can. My name is [PII], and it is spelled [PII] yes. And is that all that I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] Yeah, [PII]. Uh, can you please provide the call reference number for this one?
[AGENT][NEUTRAL] We do not give call refer for summer, Lola, but you can use my name in today's date if you need to do so, OK.
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] Can we move to next stream uh next?
[AGENT][NEUTRAL] Is it on a different person?
[CUSTOMER][NEUTRAL] Yes, different person.
[AGENT][NEUTRAL] OK, so hang on just a moment. I'm gonna put you on a brief hold, Lola.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Why here?
[AGENT][NEUTRAL] Right here gonna be about.
[AGENT][NEGATIVE] Can't get a pay right now.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Right, Lola.
[CUSTOMER][POSITIVE] Yes, lucky.
[AGENT][NEUTRAL] Alright, Lola, thanks for holding. And you said you had 11 more policy number. Go ahead with it.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah. Uh.
[CUSTOMER][POSITIVE] I'm ready with the next policy number.
[AGENT][POSITIVE] Yeah, I'll be glad to help you with one more, Lola.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah, 021.
[CUSTOMER][NEUTRAL] 35063
[AGENT][NEUTRAL] All righty, Lola. And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is uh [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] All [PII], Lola, thank you for that. Now your data service you're checking on.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Can you provide the date of service?
[AGENT][NEUTRAL] Yes, give me that date of service.
[CUSTOMER][NEUTRAL] [PII]. And the charge amount is $408 even.
[AGENT][POSITIVE] Alrighty.
[AGENT][NEUTRAL] Lola, let's see. I do see that that claim is in-house. That is for an office visit and office visits are not covered under this plan, Lola.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] So, the service is done under office visit. It is not covered under the patient's plan, right?
[AGENT][POSITIVE] That is right.
[CUSTOMER][NEUTRAL] But uh the primary is already paid under the same uh place of service, right? same visit.
[CUSTOMER][NEUTRAL] How can they be, uh, may I know the reason, uh,
[CUSTOMER][NEUTRAL] Actually, uh, the primary is the primary is BCBS and uh they already paid for the, uh, for the service.
[AGENT][NEUTRAL] Yeah, it
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] How can they be, uh, you, you're not uh
[AGENT][NEUTRAL] Yeah, but this.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] But it's not a covered benefit here, so it's not going to be covered here at all, no matter what the primary does.
[AGENT][NEGATIVE] It's not covered.
[CUSTOMER][NEUTRAL] OK, you are not follow the primary, you're not follow the primary rules, right?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, it's not a it has to be covered here to be covered, but it's not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] OK, [PII]. And uh can we move next, it is a different patient.
[AGENT][NEUTRAL] Alright, hold on.
[AGENT][NEUTRAL] Hold on just a moment for me and I can do one more and then that's it, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, hold on just.
[AGENT][NEUTRAL] A moment, Lola, let me get my notes in OK?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I'm not
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] I know.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] All right, Lola, go ahead with that last policy number, please.
[CUSTOMER][NEUTRAL] Yes. Uh.
[CUSTOMER][NEUTRAL] The policy number is uh
[CUSTOMER][NEUTRAL] 785155
[AGENT][NEUTRAL] All right, Lola, what is your patient's name and date of birth?
[AGENT][NEUTRAL] Player.
[CUSTOMER][NEUTRAL] The patient's, the patient's name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] Alrighty, and your date of service.
[CUSTOMER][NEUTRAL] Uh, [PII] and the charge amount is $1,462 even.
[AGENT][NEUTRAL] Alrighty, let's see.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] Your charge amount is 1462. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, looks, yes, sir. Looks like we have received that claim, but this patient had already maxed out their.
[CUSTOMER][POSITIVE] Yes, yes, you are.
[AGENT][NEUTRAL] 2025 benefit here, so there will be no payment.
[CUSTOMER][NEUTRAL] Sorry, laughing. Can you please repeat the reason?
[AGENT][NEUTRAL] Uh, they've already maxed their benefit out here at APL, so they have no benefits remaining, so that claim did deny.
[CUSTOMER][NEUTRAL] The maximum benefits paid.
[CUSTOMER][NEUTRAL] XX.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Mhm. Right.
[CUSTOMER][NEUTRAL] It is exceeded under dollar wise or visit wise or unit wise.
[AGENT][NEUTRAL] Dollar, Dollars.
[CUSTOMER][NEUTRAL] May I know the uh
[CUSTOMER][NEUTRAL] Last, last uh visit date.
[AGENT][NEUTRAL] Same data service but a different provider.
[CUSTOMER][NEUTRAL] So it is patient responsibility?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, loves it. Thank you. Thanks for giving information.
[AGENT][POSITIVE] You're welcome and I hope you have a great day, [PII]. Thanks for calling APL, OK.
[CUSTOMER][NEUTRAL] Yeah, bye-bye.