AccountId: 011433970860
ContactId: 5c15d24d-d7da-4887-9111-19355c9a08c9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 213229 ms
Total Talk Time (AGENT): 74349 ms
Total Talk Time (CUSTOMER): 93404 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/5c15d24d-d7da-4887-9111-19355c9a08c9_20250619T13:25_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Hi, this is [PII] here. I'm looking for a claim status. Can you please help me?
[AGENT][NEUTRAL] Sure, [PII], I can assist you with that. Can I have a
[AGENT][NEUTRAL] Callback number for you.
[CUSTOMER][NEUTRAL] Yes, it will be [PII]. That's a direct line.
[AGENT][NEUTRAL] And what is the policy number of the member that you're calling to verify? You said claim status or benefits?
[CUSTOMER][NEUTRAL] Claim status, it is 019.
[CUSTOMER][NEUTRAL] 75764 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, member's name is [PII] and date of birth of this member is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Can you spell her last name?
[CUSTOMER][NEUTRAL] Last name is uh yes, it is [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] You can't check the status of claim for what date of service?
[CUSTOMER][NEUTRAL] I'm so sorry, it's [PII].
[CUSTOMER][NEUTRAL] It will be [PII] and the charge amount of this claim is $381.92.
[AGENT][NEUTRAL] You said $381.92?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] [PII], this claim was received [PII]. It was processed [PII]. There was no payment because of CPT code 99213. Benefits are not offered under the policy, so the policy does not cover office visits.
[AGENT][NEUTRAL] The claim was submitted [PII]. It was processed [PII] for the policy, the policy does not cover office visits.
[CUSTOMER][NEUTRAL] OK, and this.
[CUSTOMER][NEUTRAL] OK. Do we have any claim number?
[AGENT][NEUTRAL] 358-626-5 is the claim number.
[CUSTOMER][NEUTRAL] Thank you. And uh this member has a medical plan, right? Just the office visits are noncovered?
[AGENT][NEUTRAL] Yes, the number did.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Got it. Thank you so much. Kindly help me out with the reference number and also your name, how do you spell it?
[AGENT][NEUTRAL] We don't provide reference numbers [PII], however, you can use my name in today's date as a reference. It's [PII] and today's date as a reference.
[CUSTOMER][NEUTRAL] 5
[CUSTOMER][NEUTRAL] OK. And uh do we, uh, can you provide me the name of the member's plan, plan name?
[AGENT][NEUTRAL] This is the midlink plan.
[AGENT][NEUTRAL] Middling gap plan.
[CUSTOMER][NEUTRAL] Main gap.
[CUSTOMER][POSITIVE] Got it. Thank you so much for helping me today. Have a nice day. Take care.
[AGENT][POSITIVE] Thanks for calling APL. You have a great one as well. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.