AccountId: 011433970860
ContactId: 7787fdf4-35e4-4f58-b563-baa7b2dc483d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 321170 ms
Total Talk Time (AGENT): 112994 ms
Total Talk Time (CUSTOMER): 67064 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/7787fdf4-35e4-4f58-b563-baa7b2dc483d_20250114T14:12_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] Hi, I'm [PII] calling from the product office to check on a claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII], and how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Only one claim.
[AGENT][NEUTRAL] OK, may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, the contact number is [PII].
[CUSTOMER][NEUTRAL] And the policy number is 02473092.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] No my name is [PII] and the date of birth is on [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 for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] Date of service is on [PII]. And the bill amount is $127.63.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold while I take a look at this claim?
[CUSTOMER][POSITIVE] Sure, sure. Take your time.
[AGENT][NEUTRAL] Thank you and also what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Johns Hopkins, Bayview Medical Center.
[AGENT][NEUTRAL] Alrighty, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Where is that?
[AGENT][NEUTRAL] What's the other one?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So we actually received the claim twice. Um, did you need the original claim or the second time we received the claim?
[CUSTOMER][NEUTRAL] Actually, I want to know the original claim status.
[AGENT][NEUTRAL] OK, so we received the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 351, I'm sorry, 354.
[AGENT][NEUTRAL] 14.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] 93
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm getting that reason again for you. Hold on one moment.
[AGENT][NEGATIVE] And it was denied because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Actually, this is a patient responsibility which has been submitted.
[CUSTOMER][NEUTRAL] For $35.
[CUSTOMER][NEUTRAL] So you, you will not cover the patient responsibility.
[AGENT][NEUTRAL] The patient's responsibility is from their primary insurance.
[AGENT][NEUTRAL] The primary insurance has their own set of benefits and then their secondary insurance has benefits. So for their secondary insurance, because it's not covered when performed in a doctor's office or clinic, there is no payment that can go out.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So this is service not covered by the
[CUSTOMER][NEUTRAL] Current patient, current benefit plan?
[AGENT][NEUTRAL] Right, it's not covered because of the patient's um policy.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Can I have the call?
[CUSTOMER][NEUTRAL] Can I have the contact number for this call?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date. So that's [PII], and then today's date.
[CUSTOMER][POSITIVE] OK. Thank you so much for your assistance and have a great day.
[AGENT][POSITIVE] You're very welcome, [PII], and thanks for calling APL. I hope you have a great day as well.
[CUSTOMER][NEUTRAL] Yeah, bye bye.
[AGENT][NEUTRAL] Bye bye.