AccountId: 011433970860
ContactId: 65e72e27-3fa5-4f0f-9aa9-b62641707b2e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 391700 ms
Total Talk Time (AGENT): 190562 ms
Total Talk Time (CUSTOMER): 103913 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/65e72e27-3fa5-4f0f-9aa9-b62641707b2e_20250306T21:15_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling from West Florida Imaging. Um, I need to see if you have received a claim from us.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, [PII], you're wanting to, uh, I'm sorry, go ahead. You're wanting to see if we've received a claim from you all. Is that correct? Yes, ma'am. I can help you with that. And [PII], how do you spell your [PII]? Mhm.
[CUSTOMER][NEUTRAL] Transferred.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Oh, wow, so do I. We're a rare breed.
[CUSTOMER][NEUTRAL] Oh, we are, we are.
[AGENT][POSITIVE] We, we are. Wow. OK. And what is a good callback number for you, [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] Well, um, the person I was speaking to that transferred me to you said that you wouldn't be able to pull it up by this, um, policy number that you would have to use your name and date of birth.
[CUSTOMER][NEUTRAL] Is that
[AGENT][NEUTRAL] Is the number you have start with a D?
[CUSTOMER][NEUTRAL] Because the number I have starts with a D.
[AGENT][NEUTRAL] No, ma'am. I can't, and I can't search by date of birth either. I can try by the name. What is the name?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And [PII] is [PII]
[CUSTOMER][NEUTRAL] It is.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I may have located a policy for her and any information that I do provide for you today would be a verification of benefits, [PII], and not a guarantee of payment. What is her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I did locate a policy for her and the correct policy number you should have for APL is 257-412-0.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the uh date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] The data service is $12725 for $99.
[AGENT][NEUTRAL] $99.
[CUSTOMER][NEUTRAL] Yes. Mhm.
[AGENT][NEUTRAL] OK, all right, thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so we did receive a claim for her for this data service. This claim was received on [PII].
[AGENT][NEUTRAL] It was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number, [PII] is 356-583-7.
[AGENT][NEUTRAL] And the reason for the denial on here states the medical test for this state of service is not a covered diagnostic test. Therefore, no benefit is payable for this claim.
[AGENT][NEUTRAL] Cover tests include MR. I can go on and read you the rest of the remark if you would like to list out all the cover tests.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][MIXED] OK, but not, cause this is a chest X-ray.
[AGENT][NEUTRAL] Yes, ma'am. It is, that is not covered.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, and are, has the EOB been sent to us?
[AGENT][NEUTRAL] Yes ma'am. It would have been mailed out the day after the processing date once it went through our nightly processing. So yes ma'am, you all should be receiving that um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Again with this claim just having them processed is probably just not had time to get to you yet, but we also have a portal that you should be able to possibly obtain this claim form. I I'm sorry, this EOB from and our portal website is secured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, secure. [PII].
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[AGENT][NEUTRAL] Yes, ma'am. So this, if the EOB wouldn't have been mailed out until probably, I mean, till the [PII] or could have been even, you know, maybe the [PII], but, so I don't think it's, it's just a matter of it hasn't had enough time to get to you yet. Mhm. Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I had.
[CUSTOMER][NEUTRAL] Yeah, OK. All right, [PII]. Well, can I just have a call reference number?
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Sure, you would use my name along with today's date.
[CUSTOMER][POSITIVE] OK. All right. Well, that's all I need. I appreciate your help.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] OK. Well, if that is all I can help you with, thank you again for calling APL [PII], and I hope you have a very nice evening.
[CUSTOMER][NEUTRAL] You too, bye-bye.
[AGENT][POSITIVE] Thank you, bye bye.
[CUSTOMER][NEUTRAL] Bye.