AccountId: 011433970860
ContactId: 8175f6ef-a9bb-4b4b-bfa5-434f2078a6a2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 417260 ms
Total Talk Time (AGENT): 132807 ms
Total Talk Time (CUSTOMER): 90713 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/8175f6ef-a9bb-4b4b-bfa5-434f2078a6a2_20250423T13:59_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling from the provider's office. I'd like to find out the status on the claim, please.
[AGENT][NEUTRAL] Yeah, of course, [PII]. I can help you with claim status today. Do you have the policy number?
[CUSTOMER][NEUTRAL] I have a 60801.
[AGENT][NEUTRAL] That looks like the group number um it should say like member ID.
[AGENT][NEUTRAL] Or policy sir.
[CUSTOMER][NEUTRAL] I don't have a copy of the card, hon I'm sorry.
[AGENT][NEUTRAL] Oh no, OK, that's OK. Do you have their first and last name?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I have a group number of 259-89.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] We'll try to look him up by his first and last name. Can you spell his first and last name for me?
[CUSTOMER][NEUTRAL] So the last name is [PII]
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Like the red dog.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] All right, let's see.
[AGENT][NEUTRAL] And then what's a good callback number in case our call gets dropped?
[CUSTOMER][NEUTRAL] Direct line is [PII].
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, and then what state is he from?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Order, OK.
[AGENT][NEUTRAL] OK, it looks like I found him.
[AGENT][NEUTRAL] OK. And then what's his date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, perfect. And then I have that policy number if you'd like it.
[CUSTOMER][POSITIVE] Oh yes please.
[AGENT][NEUTRAL] OK, it is 236.
[AGENT][NEUTRAL] 1636.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Well that was a little off.
[AGENT][POSITIVE] Yeah, it makes it easier.
[CUSTOMER][NEUTRAL] Is the group number there correct?
[AGENT][NEUTRAL] Uh, let me see.
[AGENT][NEUTRAL] Yes, the group number is 259-89 mhm.
[CUSTOMER][NEUTRAL] Hey, OK.
[CUSTOMER][POSITIVE] Alrighty then.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so do you have a uh charge amount or data service?
[CUSTOMER][NEUTRAL] Yes, it's data service 210 of $25 for 168 looks like uh the primary paid everything except for $10 and that's what we sent to you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] To pay
[AGENT][NEUTRAL] OK, just a second. It looks like I found the claim number. Um.
[AGENT][NEUTRAL] OK, so it looks like the received date for this claim is [PII]. The process date is [PII].
[AGENT][NEGATIVE] And this claim was denied.
[AGENT][NEUTRAL] See why.
[AGENT][NEUTRAL] Uh, so this claim was denied because office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] So what is covered under this kind of policy?
[AGENT][NEUTRAL] Um, accident and sickness.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And sickness?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] You said?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I don't, I guess I don't understand that if it's a sickness, he needs to go to see the doctor at an office visit.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, so some of our claims office visits are not covered.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Uh, let me look at his benefits really quick.
[CUSTOMER][NEGATIVE] It doesn't make any sense.
[AGENT][NEUTRAL] Yeah, some of these policies are.
[AGENT][NEGATIVE] Very picky, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] OK, so it looks like office visits are not covered, but, uh, treatment in office is, so it's just two different things.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] For this policy.
[CUSTOMER][NEUTRAL] My
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and then just a reference for our call please.
[AGENT][NEUTRAL] Yeah, of course. So, it's my first name, [PII]
[AGENT][NEUTRAL] Last initial [PII] and then today's date.
[CUSTOMER][POSITIVE] Appreciate the help thank you so much you have a wonderful day.
[AGENT][POSITIVE] Thank thanks for calling APL yep, have a good day.
[CUSTOMER][NEUTRAL] Mm bye bye.
[AGENT][NEUTRAL] Alright. Bye, [PII].