AccountId: 011433970860
ContactId: 6caff616-3f24-4ac5-8afc-6082b894b19a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 295380 ms
Total Talk Time (AGENT): 103803 ms
Total Talk Time (CUSTOMER): 86900 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/6caff616-3f24-4ac5-8afc-6082b894b19a_20250116T14:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi. My name is [PII] calling you from provider's office, checking on claim status.
[AGENT][NEUTRAL] May I have a callback number?
[CUSTOMER][NEUTRAL] [PII], it's the direct line.
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 01605184.
[AGENT][NEUTRAL] And you say that you're calling from the provider's office. May I have the provider's listed name?
[CUSTOMER][NEUTRAL] Would you please repeat once again?
[AGENT][NEUTRAL] I said you stated you're calling from the provider's office. May I have the provider's name?
[CUSTOMER][NEUTRAL] Yeah, the provider's name is Holy Cross Medical Group.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And may I have the date of service and total bill?
[CUSTOMER][NEUTRAL] Date of services, [PII], total charge is $728 even.
[AGENT][NEUTRAL] That is for data of service of 1127 24 total bill 728. I'm pulling that up for you now.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] May I have your name spelled, please?
[AGENT][NEUTRAL] It is spelled [PII] and today's date will be the call reference.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it does show that we did receive that claim on [PII]. It was processed on [PII]. That claim number is 354.
[AGENT][NEUTRAL] 8022 that claim process and it denied requesting the primary EOB.
[CUSTOMER][NEUTRAL] OK. The primary EOB. May I know which insurance is primary for this one?
[AGENT][NEUTRAL] You will have to get there from the policy holder.
[CUSTOMER][NEUTRAL] OK. To confirm, the claim number is 3548022. Am I right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. And uh same member, I have one more claim for different date of service and that amount. Can you please check?
[AGENT][NEUTRAL] May I have the date of service please?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII]. Total charge $665 even.
[AGENT][NEUTRAL] And you can also check claim status via our secured portal that is [PII] and I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And for that claim it does show that we received it on [PII]. It was also processed on [PII]. That claim number is 354.
[AGENT][NEUTRAL] 8062. That claim it processed and it denied that this is a non-covered benefit.
[CUSTOMER][NEUTRAL] This one is a non-covered benefits number right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Uh, that means office visits are not covered under this plan. I'm right?
[AGENT][NEUTRAL] Let me check to see if office visits are covered. Let me pull that up for you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, it is showing that office is not considered a covered benefit.
[CUSTOMER][NEUTRAL] OK, office.
[CUSTOMER][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK, just to confirm, the claim number is 3548062. I'm right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK, sure. It was great speaking with you. Have a good day. Bye-bye.
[AGENT][POSITIVE] You're welcome, thank you for calling American Public Life. Have a great day as well.
[CUSTOMER][NEUTRAL] OK