AccountId: 011433970860
ContactId: 6d8fa084-3f83-4443-87a6-f4e95834baa3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1027239 ms
Total Talk Time (AGENT): 202300 ms
Total Talk Time (CUSTOMER): 139203 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/6d8fa084-3f83-4443-87a6-f4e95834baa3_20250127T17:53_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office checking on claim status. Could you please help me with that?
[AGENT][NEUTRAL] Sure, I can assist you with claim status. And can you spell your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and may I have a callback number just in case we get disconnected, Mr. Madam?
[CUSTOMER][NEUTRAL] [PII], it's a direct line.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 01879207.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] [PII] and the date was [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah, it's
[CUSTOMER][NEUTRAL] [PII] and the bill amount $132.
[AGENT][NEUTRAL] OK, [PII] 132. Let me see if I can find this claim for you. And for future, you can check claim status online through our website at [PII] and that's just optional. Give me one moment.
[AGENT][NEUTRAL] OK, so it's been processed twice. The last time was processed as a duplicate because the first one was processed correctly and it looks like the original one was processed indicating that the service was surrendered after coverage was terminated.
[CUSTOMER][NEUTRAL] May I know when it was received and processed?
[AGENT][NEUTRAL] Mhm sure.
[AGENT][NEUTRAL] Alright, so it was received on [PII], processed [PII].
[AGENT][NEUTRAL] And this is for the original one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have 4 more clients. Could you please help me?
[AGENT][NEUTRAL] Is it the same member or different member?
[CUSTOMER][NEUTRAL] Different
[AGENT][NEUTRAL] OK, I'll have to make a note on each one before I move forward, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And what's the next policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 02369657.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, [PII], and the date of birth, [PII].
[CUSTOMER][NEUTRAL] Uh, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] May I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII] and the bill on $125 even.
[AGENT][NEUTRAL] I'm sorry, you said 100 and how much?
[CUSTOMER][NEUTRAL] $125 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That that's [PII], correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm OK. One moment.
[AGENT][NEUTRAL] Uh, one moment.
[AGENT][NEUTRAL] OK, so we received the claim on [PII], processed [PII]. Claim was denied, denied reason is office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] And not the member policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] May I know which type of plan does the member have?
[AGENT][NEUTRAL] This is, or this was a secondary supplemental plan for the major medical.
[CUSTOMER][POSITIVE] Thank you. Could you please spell out your name?
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] Thank you. May I know the time limit?
[AGENT][NEUTRAL] We don't have family family limits.
[CUSTOMER][NEUTRAL] OK, one moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Shall we move to the next one?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] I'm almost finished from my notes. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, go ahead with the next one.
[CUSTOMER][NEUTRAL] 02009122.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII]. and the date of birth is [PII].
[AGENT][NEUTRAL] OK, what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] How much is it
[CUSTOMER][NEUTRAL] And the bill amount $159 even.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. Um, let's see.
[AGENT][NEUTRAL] 029
[AGENT][NEUTRAL] Can we receive the claim on [PII] process [PII].
[AGENT][NEUTRAL] And the claim was denied as office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. Shalling what's the next one?
[AGENT][NEUTRAL] One moment, let me make a note.
[AGENT][NEUTRAL] What's the next one?
[CUSTOMER][NEUTRAL] Member ID 02009122.
[CUSTOMER][NEUTRAL] Oh, it's the same number.
[AGENT][NEUTRAL] What's the date of service?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] [PII] and the bill amount $159.
[AGENT][NEUTRAL] And you said it was for 159 as well?
[CUSTOMER][NEUTRAL] $159.
[AGENT][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] So the denial reason is the same denial reason as the previous one, and this one was processed on, let's see.
[AGENT][NEUTRAL] Uh this is received on [PII] process [PII].
[CUSTOMER][NEUTRAL] June
[AGENT][NEUTRAL] Yes, it was received [PII] processed [PII].
[CUSTOMER][NEUTRAL] And and for the same reason, right?
[AGENT][NEUTRAL] Yes, office businesses they're not covering.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Just give me one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, shelling on the last one.
[AGENT][NEUTRAL] One moment and let me make a note.
[AGENT][NEUTRAL] And it's not the same one with the matter.
[CUSTOMER][NEUTRAL] Yeah, it's different.
[AGENT][NEUTRAL] That's different, OK, one moment.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] 01792144.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] I [PII]
[CUSTOMER][NEUTRAL] [PII]. And the date of birth, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] [PII] and the bill amount $184 even.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You will received the claim on [PII], processed [PII], and denied office visits are not covered by the policy.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] May I know the call reference?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's name.
[CUSTOMER][POSITIVE] Thank you. Thank you for providing this information. That's all for today. Have a good day.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] You as well. Bye-bye.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Mm