AccountId: 011433970860
ContactId: 7ff1f18e-585e-4bb8-9702-bc00cbc41aa5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 259700 ms
Total Talk Time (AGENT): 138876 ms
Total Talk Time (CUSTOMER): 175497 ms
Interruptions: 13
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/7ff1f18e-585e-4bb8-9702-bc00cbc41aa5_20250227T19:31_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for contacting APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] 01-8730 is that right?
[CUSTOMER][NEUTRAL] Hello [PII], this is [PII] from the provider's office. I'd like to check on a claim status. How are you doing today?
[AGENT][POSITIVE] I can help. Yes, I'm fine. How are you?
[CUSTOMER][POSITIVE] I'm doing very well, thank you so much.
[AGENT][NEUTRAL] I can
[AGENT][NEUTRAL] What is the policy number that we're looking at today?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sorry, ma'am?
[AGENT][NEUTRAL] The policy number, the, so that I could look up your claim.
[CUSTOMER][NEUTRAL] Uh, all right. Yes, yes, sir. That would be 0251237777.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Patient name is um [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] Thank you. What is the data service that we're looking for, for [PII]?
[CUSTOMER][NEUTRAL] I have uh two data services. One is [PII] and the other one is, uh, yeah, we have the same date of service with uh two clients.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there a particular build amount that I should look at?
[CUSTOMER][NEUTRAL] Uh, yeah, one with $99 even another one with $26 even.
[AGENT][NEUTRAL] OK, thank you. I'm just looking that up now. Let's see.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] anything else.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Are you stated your name is?
[AGENT][NEUTRAL] Uh my name is [PII].
[AGENT][NEUTRAL] OK, so
[CUSTOMER][POSITIVE] [PII], alright have a great day.
[AGENT][NEUTRAL] Looks like the uh.
[AGENT][NEUTRAL] Claim the first claim number.
[AGENT][NEUTRAL] It's 35.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 24394.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] And you said uh uh one for $26. Let me just see here. I can find that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, the second claim number.
[AGENT][NEUTRAL] It's 352.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 4386.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Now, it looks like we received those claims.
[CUSTOMER][NEUTRAL] Yeah, I have a denial of non-covered charges for both the claims.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Right. That's correct, yes. The first one was a wellness charge. Um, we don't, we don't cover uh wellness charge at all. Um.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The policy is for sickness and accidents.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] And then the uh other charge for uh $26 the denial on that one,
[AGENT][NEUTRAL] Was uh
[CUSTOMER][NEUTRAL] I think
[AGENT][NEUTRAL] For, um, uh, any blood is drawn, anything like that, those things aren't covered. So this is really just for hospital settings. Um, if somebody is in the hospital, this is a very limited benefit policy. It's not a major medical, um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] And that's not a model.
[AGENT][NEUTRAL] So it will uh only cover certain things.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEGATIVE] And that's why those were denied.
[CUSTOMER][NEUTRAL] This is a limited service policy.
[AGENT][POSITIVE] Yes, that's correct, yes.
[CUSTOMER][NEUTRAL] May I know which services are covered under the member plan?
[AGENT][NEUTRAL] Uh, the only services that are really going to be covered, uh, will be, um, let's see.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] everything
[AGENT][NEUTRAL] Intensive care, um, there is, uh, uh, hospital benefits, um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm.
[AGENT][NEUTRAL] The emergency room, urgent care, um.
[AGENT][NEUTRAL] If a physician's office if it's for a sickness?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Uh, physical therapy that's covered, um, but the, but the, uh, but the other services, yeah, these other services are not.
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][NEUTRAL] OK. Great. And uh for both the claims, right? May I have the call reference number, [PII]?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII]. We're gonna use that today's date as our reference. Is there anything else at all I can help with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][POSITIVE] No, [PII], thank you so much.
[AGENT][POSITIVE] OK, thanks for contacting API