AccountId: 011433970860
ContactId: 5cd5ed4a-225a-49d3-a496-d30b9c948c02
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 424950 ms
Total Talk Time (AGENT): 189418 ms
Total Talk Time (CUSTOMER): 71238 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/5cd5ed4a-225a-49d3-a496-d30b9c948c02_20250515T18:59_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Rinna Group of [PII], and I was calling in regards to a patient has two claims I wanted to check on. I was trying to do it online, but it's not working.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, it's OK. I can definitely help you with the claim status. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, and the policy number?
[CUSTOMER][NEUTRAL] Uh, policy number is 02057127.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] 1st, 1st name is [PII] is the last name.
[AGENT][NEUTRAL] Thank you and the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, 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 bill for the claims?
[CUSTOMER][NEUTRAL] It will be [PII] and the bill amount is.
[CUSTOMER][NEUTRAL] It is $450.
[AGENT][NEUTRAL] And the second one?
[CUSTOMER][NEUTRAL] The second one is [PII].
[AGENT][NEUTRAL] For the same amount?
[CUSTOMER][NEUTRAL] $876.
[AGENT][NEUTRAL] 876. OK, hold on one moment.
[AGENT][NEUTRAL] October.
[AGENT][NEUTRAL] OK, so,
[AGENT][NEUTRAL] So the 7127 policy is no longer active as of [PII]. There is an active policy though that began on [PII]. Let me give you that policy number and pull that up and see if the October um data services on there because it wasn't on the one I just tried.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let me know when you're ready for the policy number.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] Alright, it's 251-3215.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment, I'm going to that one.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] So for the [PII].
[AGENT][NEUTRAL] Actually, do you mind if I place you on just a brief hold so I can just make sure for these two?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh that is 340. What was the total bill? 353-8068.
[AGENT][NEUTRAL] And while we're here.
[AGENT][NEUTRAL] 356-4080.
[AGENT][NEUTRAL] No, it's 3:40.
[AGENT][NEUTRAL] Let's try the next one.
[AGENT][NEUTRAL] 080.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So the reason I was hesitant is because we do have a claim here on each of those dates of service, but it's a different total bill. Um, what's the name of your facility?
[CUSTOMER][NEUTRAL] Retina Group of Florida or Retina Virtuous Consultants?
[AGENT][NEUTRAL] OK, it's the same provider. Um,
[AGENT][NEUTRAL] So the one that came in, well, let me do this. What's your tax ID just in case?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] No, it's the same. OK, so the one that came in on [PII], well, the one for [PII], um, it's claim number 353.
[AGENT][NEUTRAL] 8068, but it has a total bill of $340. Did you still want the dates for that one?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so we received this claim on [PII].
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered by this policy.
[AGENT][NEUTRAL] And then um for [PII], we received that claim on [PII].
[AGENT][NEUTRAL] The claim number is 356-4080.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Let me get that one for you.
[AGENT][NEUTRAL] Because the service is not um covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there an initial of your last name?
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] Is there a reference number or just today's date?
[AGENT][NEUTRAL] Um, no call reference number, just my name and today's date.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. Was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] No, that was it.
[AGENT][POSITIVE] Alright, thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.