AccountId: 011433970860
ContactId: 732d1c69-8afb-44ee-a7b5-57eb1b2d83c9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 566099 ms
Total Talk Time (AGENT): 140013 ms
Total Talk Time (CUSTOMER): 85594 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=-0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/732d1c69-8afb-44ee-a7b5-57eb1b2d83c9_20250131T18:22_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I assist you?
[CUSTOMER][NEUTRAL] Yes, I am calling for claim status. My name is [PII].
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status, Ms. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And you're calling from which facility?
[CUSTOMER][NEUTRAL] It's Hogue Clinic.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure, let me get it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's 01988261.
[AGENT][POSITIVE] Mm, thank you.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It's for [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][POSITIVE] All right then, thank you.
[AGENT][NEUTRAL] And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, how much is the total charge?
[CUSTOMER][NEUTRAL] Total charge is.
[CUSTOMER][NEUTRAL] $127.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right, let me pull this EOB and for future, you can check claim status online through our website at [PII] and that's just optional. And let's see one moment.
[CUSTOMER][NEUTRAL] I'm sorry, what was the website again secure.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII]. Alright, thank you.
[AGENT][POSITIVE] Mhm. You're welcome.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And I'm still waiting on the documents. I do apologize.
[AGENT][NEUTRAL] All right, so it looks like we processed the claim [PII] and the claim was denied. The denial reason is that the policy provides no benefits for treatment of condition other than sickness or injury.
[CUSTOMER][NEUTRAL] OK, no benefits for treatment?
[AGENT][NEUTRAL] No, we do not cover preventative. Preventatives are not covered under this policy. Mhm, yeah.
[CUSTOMER][NEUTRAL] Oh, that's what it is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, so that can you tell me when the claim was received?
[AGENT][POSITIVE] Um, yeah, I need to get that for you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it was received [PII], process [PII].
[CUSTOMER][NEUTRAL] Alright, and do you have the claim number?
[AGENT][NEUTRAL] The claim number is 3521194.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] And let's see if we want to appeal this for any reason, um, where would we send that to?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] All right, and then is there a reference number for the call?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's state if you will.
[CUSTOMER][NEUTRAL] And then as far as the denial, are we able to um obtain a copy of that EOB?
[AGENT][NEUTRAL] Um, yes, and do you need it fax?
[CUSTOMER][NEUTRAL] That would be fine.
[AGENT][NEUTRAL] OK, what is the fax number, Miss [PII]?
[CUSTOMER][NEUTRAL] It's uh [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Mhm, that's correct.
[AGENT][NEUTRAL] OK. Do you mind holding for me while I send this out to you while I got you on the line? Thank you. One moment. OK, thank you.
[CUSTOMER][NEUTRAL] Sure, sure, that's fine.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Miss [PII]. OK, I went ahead and send that over to you. Should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, that would be it, and you said there's no reference number, right?
[AGENT][NEUTRAL] No, just my name and today's date.
[CUSTOMER][NEUTRAL] OK, and how do I spell your name?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][POSITIVE] All right thank you so much.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Mhm you too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.