AccountId: 011433970860
ContactId: 78e68022-9a05-498f-a708-d0b181f9a9b4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 244820 ms
Total Talk Time (AGENT): 80658 ms
Total Talk Time (CUSTOMER): 94875 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/78e68022-9a05-498f-a708-d0b181f9a9b4_20250326T16:33_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. This is [PII]. I'm calling for the provider to check on additional information about a claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes. How are you doing today, [PII]?
[AGENT][POSITIVE] I'm doing good. How about you?
[CUSTOMER][POSITIVE] Yeah, I'm doing great, [PII]. Thank you so much for asking.
[AGENT][NEUTRAL] OK, [PII], I can check that claim status for you. Can I get a good callback number?
[CUSTOMER][NEUTRAL] Uh, sure, it is [PII] and it is a direct line.
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Uh yes. Uh, the policy number here I have is, it's uh 01631918.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh, so for this one, the patient's name is
[CUSTOMER][NEUTRAL] Uh, [PII], and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And what was that date of service?
[CUSTOMER][NEUTRAL] So, it's uh [PII], uh with the total bill amount of photos.
[CUSTOMER][NEUTRAL] With the total amount of $275.50.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Uh, looks like these are non-covered services under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So which means, so uh it is a non-covered services and the member's policy, am I right?
[AGENT][NEUTRAL] Yes, and we received the claim on 225-2025.
[AGENT][NEUTRAL] That was denied on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. And may I know the member's plan?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, may I know the member's plan?
[AGENT][NEUTRAL] The plan, what do you mean? Like the benefit or what or the claim?
[CUSTOMER][NEUTRAL] Uh, so the members, uh, plan type.
[AGENT][NEUTRAL] Oh, the effective date of the policy?
[CUSTOMER][NEUTRAL] Uh, no, no, no, the members plan type.
[CUSTOMER][NEUTRAL] HHMO PPO R P P Y.
[AGENT][NEUTRAL] The plan
[AGENT][NEUTRAL] Oh, this is a, this is a, um, supplemental policy. It's not a major medical.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Got it. Uh, it's a supplemental plan GFRD.
[AGENT][NEUTRAL] Yeah, supplemental plan, um, it just works in conjunction with the primary.
[AGENT][NEUTRAL] Major medical.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Thank you so much, and there is no uh letter G for DMR, right? It's only the supplemental plan.
[AGENT][POSITIVE] Yes, it's an only, yes, correct.
[CUSTOMER][POSITIVE] Sure, sure. Thank you so much, [PII]. No problem, ma'am. Can I have the uh card number of the call today?
[AGENT][NEUTRAL] Uh, reference number will just be my first name, last initial. It's [PII], and that's S [PII]. Today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] Got it. Thanks.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. Uh, have a great day and take care of yourself. Stay safe, [PII].
[AGENT][POSITIVE] OK, thank you, [PII]. Have a great day. Thank you for calling APL.
[CUSTOMER][POSITIVE] Bye-bye. Thank you so much.
[AGENT][NEUTRAL] Mm bye.