AccountId: 011433970860
ContactId: 6ec4a0f8-dfd3-4455-beb9-4bfaf0b4f3ee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 240649 ms
Total Talk Time (AGENT): 89387 ms
Total Talk Time (CUSTOMER): 103765 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/6ec4a0f8-dfd3-4455-beb9-4bfaf0b4f3ee_20250116T15:04_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] Resources. Can you hear me?
[AGENT][NEUTRAL] I can.
[CUSTOMER][NEUTRAL] OK sorry my phone rang through my computer so I'm like oh my goodness anyway I have a person a provider on the line that's needing to verify benefits on this policy you're ready?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's 24502 no I'm sorry 2450157.
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] And who are they verifying benefits for?
[AGENT][NEUTRAL] OK, you can send them over. Did they verify everything, or do I need to get that from them?
[CUSTOMER][NEUTRAL] Um, on, on participant number one and the lady.
[CUSTOMER][NEUTRAL] I verify the date of birth. I didn't need to verify her address or anything, but the person on the phone is, her name is [PII]. Let me spell it. It's [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And she's with the provider. I forgot to ask her for her callback number.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] I think this is the [PII] number.
[CUSTOMER][NEUTRAL] Um, hang on.
[CUSTOMER][NEUTRAL] Uh, yeah, [PII].
[AGENT][POSITIVE] Mhm, you can send over. I'll be able to assist her.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome. Have a good one.
[CUSTOMER][NEUTRAL] Are you still there?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes,
[AGENT][NEUTRAL] OK. Yeah, I'm here.
[CUSTOMER][NEUTRAL] Well, hang on a second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is the provider on there?
[AGENT][NEUTRAL] I think.
[AGENT][NEUTRAL] Yeah I think she is. I think she just said something.
[CUSTOMER][NEUTRAL] Looks like she was.
[CUSTOMER][POSITIVE] OK, well, I'm gonna transfer it for forever. Thank you.
[AGENT][POSITIVE] You're welcome. Have a good one.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello, my name is [PII]. I'll be assisting you today. You were calling in regards to benefits for [PII].
[CUSTOMER][NEUTRAL] Yeah, it's regarding claims actually.
[AGENT][NEUTRAL] What's the date of service that you're inquiring claim status for?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Could you verify the procedure code and I'll be able to assist you.
[CUSTOMER][NEUTRAL] OK, um, do you need all the procedure codes?
[AGENT][NEUTRAL] Just one.
[CUSTOMER][NEUTRAL] OK 992.
[CUSTOMER][NEUTRAL] 04.
[AGENT][NEUTRAL] For the amount of 240.
[CUSTOMER][NEUTRAL] 99204.
[AGENT][NEUTRAL] The procedure
[AGENT][NEUTRAL] This claim was received [PII]. It was processed [PII]. There was no payment made on the claim because office visits are not covered.
[AGENT][NEGATIVE] And then the primary did not make any benefits.
[AGENT][NEUTRAL] Pay any benefits towards the services received.
[CUSTOMER][NEUTRAL] So the office visits are not covered?
[AGENT][NEUTRAL] Correct, the member's policy does not cover office visits.
[CUSTOMER][NEUTRAL] Oh OK and.
[AGENT][NEUTRAL] It only covers the treatment received in the office. However, the provider did not make any make any payments towards any deductible, co-pay or co-insurance.
[CUSTOMER][NEGATIVE] I'm sorry, like, your phone is cutting off. I can't hear you well.
[AGENT][NEGATIVE] Office visits are not covered for the policy. The member's policy does not have benefits for office visits.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Well, I think that's it thank you so much. Can you give me just a reference number?
[AGENT][NEUTRAL] You're welcome. Would you like for me to verify the benefits for the reference number we don't provide those, but I can give you a claim number. Would you like the claim number?
[CUSTOMER][NEUTRAL] Um, yeah, and can you also verify the benefits please, please.
[AGENT][NEUTRAL] Can I verify what?
[CUSTOMER][POSITIVE] The benefits.
[AGENT][NEUTRAL] Could you repeat yourself?