AccountId: 011433970860
ContactId: 75547d45-9686-4932-b837-c25ee0eb13d6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 485880 ms
Total Talk Time (AGENT): 159046 ms
Total Talk Time (CUSTOMER): 120281 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/75547d45-9686-4932-b837-c25ee0eb13d6_20250602T14:52_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Hi, this is [PII] and my is [PII] calling from provider's office to check on a claim status. If you don't mind, could you please spell your name for me?
[AGENT][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] And I'll be more than happy to help you with the claim status, [PII]. May I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, my callback number is [PII]. And the policy number is 02201787 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Sure. [PII] with the bill amount 4 $44 even.
[AGENT][NEUTRAL] Are you saying $444 or $44 even?
[CUSTOMER][NEUTRAL] $444 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so I'm not showing a claim on file for [PII] for [PII]. Let me see if there are any other policies. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No, this is
[AGENT][NEUTRAL] This is the only one that was. OK, so this is the only policy that was active during the day of service, but there's no claim on file. Um, you can still file, there's no timely filing limit.
[CUSTOMER][NEUTRAL] OK, if there is no claim on file, may I get the.
[CUSTOMER][NEUTRAL] Member effective and term dates, please.
[AGENT][NEUTRAL] The policy is still active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] OK, give me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] May I get the mail mailing address, please?
[AGENT][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, may I get the payer ID please?
[AGENT][NEUTRAL] Sure, it's 60801.
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] And I have one more member to check. Can you please provide me the status, please?
[AGENT][NEUTRAL] OK, hold on one moment, let me note this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] 02377438 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] All right. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And again, all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] [PII] with the valid amount to not $1 even.
[AGENT][NEUTRAL] Can you say that slowly, please? Did you say $221?
[CUSTOMER][NEUTRAL] 201.
[AGENT][NEUTRAL] $201. OK, thank you.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, so I'm showing the claim was received on [PII].
[CUSTOMER][NEUTRAL] And processed on
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the claim number is 352.
[CUSTOMER][NEUTRAL] And may I know the dinner.
[AGENT][NEUTRAL] I'm going to give you all the information. Hold on one moment. The claim number is 352.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 73
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 27
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim was denied because.
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The claim was denied because office visits are not covered on the policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Give me a moment.
[CUSTOMER][POSITIVE] OK, thank you so much for patiently waiting on the line. May I know the provider discount and patient responsibility, please?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] We don't determine patient responsibility because we're not the major medical insurance company and there was nothing applied to this claim.
[CUSTOMER][NEUTRAL] OK, you're saying there is no such information with you, am I right?
[AGENT][NEUTRAL] I'm stating that we do not provide patient responsibility because we're not a major medical insurance company. So that would be whatever you as a provider, how you handle it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Was there anything else I could assist you with today, [PII]?
[CUSTOMER][POSITIVE] OK, thank you so much. And may I get the call reference number, please?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][POSITIVE] OK, thank you so much. Have a nice day. Stay safe. Bye for now.
[AGENT][POSITIVE] You also, was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] Uh, thank you so much, [PII], for asking. I got the required info from you today. Have a nice day ahead.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] You also, thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah