AccountId: 011433970860
ContactId: 7a91ea2a-94ad-46b8-80f7-7ad2eba52053
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 255350 ms
Total Talk Time (AGENT): 89840 ms
Total Talk Time (CUSTOMER): 84661 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/7a91ea2a-94ad-46b8-80f7-7ad2eba52053_20250204T19:42_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. Last name initial is [PII], and I am calling from Laboratory Corporation of America, and this line will be recorded for training and quality purposes. I am calling about the claim status we submitted for one of our mutual patients. Can you please help me with this?
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh yes, it's [PII].
[AGENT][NEUTRAL] And what was the last the first three numbers [PII] and then what did you say it went in and out?
[CUSTOMER][NEUTRAL] Uh, that's fine. It's [PII].
[AGENT][NEUTRAL] OK, with a 9. Alrighty. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] It's um 255-579-8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, sure. First name is [PII]. Last name is [PII]. 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 for the claim you want me to take a look at?
[CUSTOMER][NEUTRAL] Uh, sure. It's um [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] It's $191.65.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Uh, sure, uh, just a moment.
[AGENT][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] It's a LabCorp Dallas Cisto or Laboratory Corporation of America.
[AGENT][NEUTRAL] OK, hold on one moment, this is it.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So I'm trying to received the claim on November, I'm sorry, November [PII], 2024.
[AGENT][NEUTRAL] The claim number is
[AGENT][NEUTRAL] 352-656-6
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Because benefits payable under this certificate are limited to those outlined on the schedule of benefits.
[AGENT][NEUTRAL] This is not a covered loss under the plan. Therefore, there is no amount payable.
[CUSTOMER][NEUTRAL] Alright, uh, may I know if there is a patient responsibility for this claim?
[AGENT][NEUTRAL] So we don't determine patient responsibility because we're not a major medical insurance company.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Alright, um, I think I've got all the information I needed for now. Thank you so much and uh and for my documentation purposes, can you please have your initial last name and the call reference number?
[AGENT][NEUTRAL] Sure, it's L as in Larry, and there's no call reference number, but you can use my name and today's date.
[CUSTOMER][NEUTRAL] Name and your initial last name, right?
[AGENT][NEUTRAL] Yes, my first name is [PII], initial [PII], and then today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alright, thank you so much [PII] for taking the time to answer my call and helping me today. Have a great day bye bye for now.
[AGENT][POSITIVE] Thank you also and thanks for calling APL. Bye-bye.