AccountId: 011433970860
ContactId: 7043a111-d040-4712-98ea-d1bce6d473cb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 426739 ms
Total Talk Time (AGENT): 167402 ms
Total Talk Time (CUSTOMER): 78960 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/7043a111-d040-4712-98ea-d1bce6d473cb_20250508T14:05_UTC.wav
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[AGENT][POSITIVE] Good morning, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII] calling from provider's office to check on claims.
[AGENT][NEUTRAL] I'm sorry, your voice faded out and I did not hear your name.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And [PII], you said you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] Thank you and how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] 3 claims for the same patient.
[AGENT][NEUTRAL] OK, so you will, I can help you with this, and you will use my name [PII] along with today's date as your call reference number. Also, any information that is provided will be a verification of benefits and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] And then lastly, if we do have the claims on file and you need a copy of the uh explanation of benefits here you can print those once you have the claim number by going to our portal at [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and what is your patient's policy number, please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] 01997050
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what is your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the first date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] It's [PII] with the bill amount of $408 even.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Well
[AGENT][NEUTRAL] OK, so this claim was received, the received date on it. Just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This claim was received on [PII].
[AGENT][NEGATIVE] Processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is going to be 358.
[AGENT][NEUTRAL] 7385
[AGENT][NEUTRAL] And the reason for the denial on here, Tara, is that office visits are not covered by the above numbered policy. The member's plan does not cover office visits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] You're welcome. And what is the next data service in total bill amount?
[CUSTOMER][NEUTRAL] Yes, um,
[CUSTOMER][NEUTRAL] The next amount.
[CUSTOMER][NEUTRAL] It would be [PII] with the billed amount of $408 even.
[AGENT][NEUTRAL] Same bill amount. OK, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you said [PII]. Is that correct?
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, this claim was also received.
[AGENT][NEUTRAL] The receipt date on this will be.
[AGENT][NEUTRAL] 48.
[AGENT][NEGATIVE] Processed on [PII], it was denied.
[AGENT][NEUTRAL] The claim number is 3587437.
[AGENT][NEGATIVE] And it was denied for the same reason, office visits are not covered.
[CUSTOMER][NEUTRAL] OK. Thank you, [PII]. Uh, shall we move on to the last date of service?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] It would be [PII] with the bill amount of $408 even.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this claim was also received.
[AGENT][NEUTRAL] And one moment and I'll provide you that information. This one was received on [PII] as well, processed on [PII].
[AGENT][NEUTRAL] The claim number is 3587417.
[AGENT][NEGATIVE] And it was denied for the same reason, office visits are not covered.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII], for your assistance. That's all for today.
[AGENT][POSITIVE] Absolutely. OK, well, if that is all I could help you with, thank you again for calling APL and I hope you have a great day, [PII].
[CUSTOMER][POSITIVE] Thank you. Bye for now.
[AGENT][NEUTRAL] Um, bye bye.