AccountId: 011433970860
ContactId: 6221b224-67f0-4902-83e7-0c34e41cdf48
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 538059 ms
Total Talk Time (AGENT): 125781 ms
Total Talk Time (CUSTOMER): 110407 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/6221b224-67f0-4902-83e7-0c34e41cdf48_20250618T18:31_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, I'm [PII] calling for provider's office to check on a claim status.
[AGENT][POSITIVE] Hey [PII], well, I'll be more than happy to help you with your claim status. May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. It's uh [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Only one.
[AGENT][NEUTRAL] Alright, and may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure. Just one second. The member's policy number is 01851923 M as in Mike, L as in Lima.
[CUSTOMER][NEUTRAL] 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure. Uh, the member's name.
[CUSTOMER][NEUTRAL] member's name is [PII] and the last name is [PII] and the date of birth is for [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 bill for the claim?
[CUSTOMER][NEUTRAL] A data services for.
[CUSTOMER][NEUTRAL] [PII]. And the total charge amount is uh $658 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment, and that was [PII] for $658.
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] Alright, now, is it OK if I place you on just a brief hold, we received a few claims that day. I'm just searching for your claim.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, hold on one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] All right, thank you so much for holding. I apologize for that wait. So, the original claim um we received on [PII].
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Claim number is 349.
[AGENT][NEUTRAL] 7472.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because the services are not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Mhm, just give me one second.
[CUSTOMER][POSITIVE] Thank you so much, sir. Uh, it's not good the provider's contract, right?
[AGENT][NEGATIVE] I'm not covered under the member's policy.
[CUSTOMER][POSITIVE] OK, uh thank you so much, sir.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] And uh could you please uh fax me a copy of UOB to a fax number cause we haven't received OB from your side yet. Thank you so much, sir. Uh, the fax number is 813.
[AGENT][NEUTRAL] Sure, what's
[CUSTOMER][NEUTRAL] 278-7075 and attention to my name which is [PII], the last name is [PII].
[AGENT][NEUTRAL] That was [PII].
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][POSITIVE] All right. Well, I will go ahead and send this explanation of benefits over to you now. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Uh, thank you so much. And in this case, can we, uh, bill to patient?
[AGENT][NEUTRAL] Uh, we don't determine patient responsibility because we're not the major medical. The outstanding balance, um, would be up to you as a provider to determine next steps.
[CUSTOMER][NEUTRAL] OK, got it. Thank you so much. Uh, uh, just a last question, is the provider is, uh, uh, in network, uh, with the patient's plan?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So this is a Metlink supplemental gap insurance, so there's no network for the secondary insurance. It would be the primary that would deal with the network.
[CUSTOMER][POSITIVE] Oh, got it. Thank you so much. And yes, I'm ready for the reference number for this call.
[AGENT][NEUTRAL] Alright, so there's no call reference number, but you can use my name and today's date. And again, that's [PII] to my last [PII] is [PII].
[CUSTOMER][POSITIVE] Thank you so much and thank you so much for information provided. Have a great day. Take care.
[AGENT][POSITIVE] You're welcome. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Oh thank you so much.
[AGENT][POSITIVE] Thanks for calling APR [PII]. I hope you have a good day.
[CUSTOMER][NEUTRAL] You as well bye.
[AGENT][POSITIVE] Thank you. Bye-bye.