AccountId: 011433970860
ContactId: 5bc8f668-f075-4687-b0d1-37704727aef5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 196190 ms
Total Talk Time (AGENT): 85851 ms
Total Talk Time (CUSTOMER): 61615 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/5bc8f668-f075-4687-b0d1-37704727aef5_20250530T15:08_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] with Oklahoma Medical Eye Group. I need to check on the status of a claim.
[AGENT][NEUTRAL] OK, I can help you with the claim status. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] 02264457
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [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 and the total bills for the claim?
[CUSTOMER][NEUTRAL] Yes, it is [PII] for $257.78.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so I believe I just found it. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You said the total balance was 257 78 cents?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This is it.
[AGENT][NEUTRAL] So I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim number is 359.
[AGENT][NEUTRAL] 0215.
[CUSTOMER][NEUTRAL] Oh, you know what.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] Um, we'll go into.
[AGENT][NEUTRAL] Because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK, so it doesn't cover doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK, um, is it just hospital that it covers?
[AGENT][NEUTRAL] Um, let me see, hold on one moment.
[CUSTOMER][NEUTRAL] our
[AGENT][NEUTRAL] Well, it covers inpatient and outpatient facilities, um, but under outpatient, they don't have the office treatment rider which will cover the treatment in the office, so there's no in-office setting. It's more like urgent care, emergency room.
[CUSTOMER][NEUTRAL] we
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] You're welcome. Bye bye
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK perfect all right thank you.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that's all, other than a reference number if you have one.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. And again, that's [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome and thanks for calling APO have a great weekend.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.