AccountId: 011433970860
ContactId: 7d4a87f6-d717-4928-ae09-c42fe8f24512
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 163750 ms
Total Talk Time (AGENT): 57448 ms
Total Talk Time (CUSTOMER): 78158 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/7d4a87f6-d717-4928-ae09-c42fe8f24512_20250505T14:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. um, I'm calling from a provider's office and I was hoping to speak to someone about a member's claim denial that we received.
[AGENT][NEUTRAL] OK, yeah, I can check that claim for you. We're just needing clarification on that.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] Yes, yes, I am.
[AGENT][POSITIVE] Definitely I can check that for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Of course, um, that's gonna be 502.
[CUSTOMER][NEUTRAL] 907.
[CUSTOMER][NEUTRAL] 0356
[AGENT][NEUTRAL] OK, thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, I believe so. It looks like the policy number that we have is 022.
[CUSTOMER][NEUTRAL] 223.
[CUSTOMER][NEUTRAL] 88.
[AGENT][NEUTRAL] Got it. And what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] Sure. Uh, this is [PII]. Date of birth [PII].
[AGENT][POSITIVE] Perfect thank you so much for verifying that [PII]. uh, now do you have the claim number?
[CUSTOMER][NEUTRAL] Um, I might, I believe I do. Give me a moment here.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Claim number.
[CUSTOMER][NEUTRAL] OK, the claim number that it shows here is 34.
[CUSTOMER][NEUTRAL] 90.
[CUSTOMER][NEUTRAL] 185.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][POSITIVE] Yeah, no problem.
[AGENT][NEUTRAL] OK, so it looks like on this claim we did pay a benefit of $50 which was the maximum amount payable for the date of service, so this is a limited indemnity medical plan, so it just pays a set dollar amount per covered procedure or office visit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I see, got you, so I was just calling because I know two of the lines didn't pay, so I was like, oh, I wonder if, you know, I just wanted more details on that, but that makes sense. So he just has a plan that.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Sure, not necessarily that they're not covered. It was just that, yes, exactly.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, all right, I'll go ahead and note that. Thank you for explaining that uh to me. I think that's all the questions I had today.
[AGENT][NEUTRAL] Of course
[AGENT][POSITIVE] Alright, yeah, well thanks for giving us a call [PII]. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too goodbye.
[AGENT][POSITIVE] Thank you. Bye-bye.