AccountId: 011433970860
ContactId: 7ba38976-11ca-43f0-b227-64811b01d1f7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 451899 ms
Total Talk Time (AGENT): 151414 ms
Total Talk Time (CUSTOMER): 132972 ms
Interruptions: 4
Overall Sentiment: AGENT=1.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/7ba38976-11ca-43f0-b227-64811b01d1f7_20250620T18:18_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Uh, my name is [PII]. I'm calling from uh dermatology Group of Florida. I'm just looking for, um, details, uh, or status on a claim, two claims that I have.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Um, it is [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the policy number, please?
[CUSTOMER][NEUTRAL] Yes, um, that is.
[CUSTOMER][NEUTRAL] 01813211 M as in Mike L as in Lima 8.
[AGENT][POSITIVE] OK, thank you very much. Give me one second, let me just repeat that. I have.
[AGENT][NEUTRAL] 01813211 ML8.
[CUSTOMER][NEUTRAL] Let me see, hold on, I gotta go back to 01813211 ML8 yes.
[AGENT][NEUTRAL] OK, thank you. And verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you, and you're calling for claims status and I can assist you. What is that date of service and the total charge amount?
[CUSTOMER][NEUTRAL] Uh, it's [PII]. It's a billable amount of $257.60.
[AGENT][NEUTRAL] 67. OK, thank you. I will tell you that this is an old policy. It shows that it turned as of Decem excuse me, [PII].
[AGENT][NEUTRAL] Give me one moment just to check for an active policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now I'll provide those details to you as well. One second.
[CUSTOMER][POSITIVE] Great I appreciate it thank you.
[AGENT][NEUTRAL] OK, of course. And I have that policy number for you when you are ready.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] 025560418.
[CUSTOMER][NEUTRAL] OK, so 0255604.
[CUSTOMER][NEUTRAL] 1 ML 8.
[AGENT][NEUTRAL] Yes, yes, now let me check for that status for you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And just to verify, is that date of service [PII] or [PII]?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright thank you so much and it shows that the claim was received and it denied as office visits are not covered by the policy. Give me one moment to get those claim details for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It shows that the claim was received on [PII].
[AGENT][NEUTRAL] [PII] processed and denied on [PII].
[AGENT][NEUTRAL] And I'll also have that claim number for you as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and it doesn't, um, so that the her plan doesn't cover office visits?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, um, so would that be member responsibility then we can build a patient for that?
[AGENT][NEUTRAL] Um, APL does not determine patients responsibility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, I do have a couple other ones if you could help me quickly with those.
[AGENT][NEUTRAL] OK, uh, before that, would you like the claim number associated with this?
[AGENT][NEUTRAL] Particular
[AGENT][NEUTRAL] Remember
[CUSTOMER][NEUTRAL] Uh, I'm sorry. You, you keep right, you're in and out, so if I have to ask you to repeat again.
[CUSTOMER][NEUTRAL] It's, it's only because I can't, you know, I'm getting some.
[AGENT][POSITIVE] OK, no worries.
[CUSTOMER][NEUTRAL] That's OK. Um, I mean, our
[AGENT][NEUTRAL] Uh, no worries. Would you like the claim number?
[CUSTOMER][NEGATIVE] Do we, do we really need the claim number? I mean, it's not really gonna do us any good to dispute it if it's not covered, it's not covered. You're not gonna pay for it, right?
[AGENT][NEUTRAL] Well, that's correct. I didn't know if you needed it for your records as far as um.
[CUSTOMER][NEGATIVE] Oh no.
[AGENT][NEUTRAL] Documentation or I'm I'm not sure but if you don't need it that's fine. OK, no worries OK and give me one moment please.
[CUSTOMER][NEUTRAL] Yeah, no, I don't, I.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] If there is a separate reference number though.
[AGENT][NEUTRAL] Let me place you on a brief hold, please, [PII].
[CUSTOMER][NEUTRAL] Oh, yeah, yeah. Go ahead.
[AGENT][NEUTRAL] OK, and in regards to the reference number, we do not use reference numbers but you can use my name and today's date.
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] I'm ready for the next policy number.
[CUSTOMER][NEUTRAL] OK, um, oh, you know what? I just submitted this one, never mind.
[CUSTOMER][POSITIVE] I'm gonna skip this one. nope, I think we're good. I'm sorry.
[AGENT][POSITIVE] No problem, no problem. And also [PII], you're able to check claim status by visiting our secure portal at [PII] as well. So that's another avenue that you're able to check claim status.
[CUSTOMER][POSITIVE] OK, I appreciate that thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling APL take care.
[CUSTOMER][POSITIVE] Thank you. You too.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Mm bye.