AccountId: 011433970860
ContactId: 850a04bf-0ae2-4633-bb7c-6fea86f11ffa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 387690 ms
Total Talk Time (AGENT): 168592 ms
Total Talk Time (CUSTOMER): 94628 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/850a04bf-0ae2-4633-bb7c-6fea86f11ffa_20250611T16:26_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm looking for a claim status.
[AGENT][NEUTRAL] [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Yeah, callback number is [PII].
[AGENT][POSITIVE] Thank you very much. What is that policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number is
[CUSTOMER][NEUTRAL] D as in Delta, 45401585.
[AGENT][NEUTRAL] OK, one moment please, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What is the patient's last name?
[CUSTOMER][NEUTRAL] Yeah, last name is [PII].
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] First name is [PII].
[AGENT][NEUTRAL] [PII], OK. And if you would spell that for me, please.
[CUSTOMER][NEUTRAL] OK. Uh, first one or last?
[AGENT][NEUTRAL] And just spell the first name for me, please.
[CUSTOMER][NEUTRAL] OK. [PII]
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And the last name is [PII]
[AGENT][POSITIVE] OK, thank you so much. I appreciate that. One moment please as I search my system.
[AGENT][NEUTRAL] And this is a medical claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it's medical claim, right.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of birth for the member?
[CUSTOMER][NEUTRAL] Yeah, the date of birth is [PII].
[AGENT][NEUTRAL] OK, I'm still searching for the member in our system. Now, would you happen to have a policy certificate number?
[CUSTOMER][NEUTRAL] Uh, no, I don't have.
[AGENT][NEUTRAL] OK, just bear with me please, [PII].
[CUSTOMER][NEUTRAL] I update of service and the bill amount.
[AGENT][NEUTRAL] One moment, I'm still searching.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Would you happen to have the social for the number?
[CUSTOMER][NEUTRAL] Uh, no, I don't have.
[AGENT][NEUTRAL] OK, thank you, and again just bear with me please as I search the system.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. And what is it? I'm sorry, the date of birth you said it was [PII]. OK, I think I have it here and I appreciate your patience with me. OK, thank you. Now I'm ready for that date of service and total charge amount please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII] and the bill amount is $320 even.
[AGENT][NEUTRAL] I'm sorry, if you could repeat the date of service again for me.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII].
[AGENT][POSITIVE] OK, thank you so much. I appreciate that.
[AGENT][NEUTRAL] OK, I was able to locate that claim. Give me one moment to get you the.
[AGENT][NEUTRAL] Denial reason. One moment please, [PII]. Thank you.
[AGENT][NEUTRAL] OK, it shows that the claim we received it on [PII]. It was processed and denied on [PII].
[AGENT][NEUTRAL] And the charges denied as?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, for procedure code 96127.
[AGENT][NEUTRAL] Denied as there is no benefit for a service other than a sickness or an injury. So that has to be due to a sickness or injury, not a preventative visit.
[AGENT][NEUTRAL] And that was for 961-27.
[CUSTOMER][NEUTRAL] OK, so could you
[CUSTOMER][NEUTRAL] OK, so could you please let me know what is the exact denial in short term, short form?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, one moment.
[AGENT][NEUTRAL] OK, for procedure code 96127.
[AGENT][NEUTRAL] It states policy provides no benefits for the treatment of conditions other than a sickness or injury.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, no problem. And what is the claim number?
[AGENT][NEUTRAL] Claim number is 3583243.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh could you please send the copy of your to my fax number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can, um, [PII], what is your fax number?
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Yeah, the fax number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII], let me just repeat that to confirm. I have that as [PII].
[CUSTOMER][POSITIVE] [PII]. Yeah, perfect.
[AGENT][NEUTRAL] OK, now.
[CUSTOMER][NEUTRAL] OK. And what is the call reference number?
[AGENT][NEUTRAL] Um, [PII], we do not use call reference numbers. You can use my name [PII] last initial [PII] like [PII] in today's date. Excuse me, one moment please, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Excuse me, sorry about that. You can also check claim status by visiting our secure portal at [PII], and on that website you can actually obtain an EOB, but I will fax over this EOB to you. Anything else I can help you with, please, [PII]?
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][POSITIVE] 00, no, [PII], thank you so much. Have a nice day. Bye-bye.
[AGENT][POSITIVE] Mm thank you for calling AL. Take care bye bye.