AccountId: 011433970860
ContactId: 850f15de-1723-42f8-94c7-cef87bb79c7d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 473779 ms
Total Talk Time (AGENT): 146592 ms
Total Talk Time (CUSTOMER): 144450 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/850f15de-1723-42f8-94c7-cef87bb79c7d_20250609T14:18_UTC.wav
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[CUSTOMER][NEUTRAL] Well
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, my name is [PII], and I'm calling to check claim status.
[AGENT][POSITIVE] OK, well I'll be more than happy to help you with the claim status, [PII], and how many claims do you have in total today?
[CUSTOMER][NEGATIVE] I have 3 claims, uh, different members under the same provider.
[AGENT][NEUTRAL] OK, and may I have a good contact number in case we're disconnected and the first member's policy number?
[CUSTOMER][NEUTRAL] Uh yeah, sure. Contact number is [PII].
[CUSTOMER][NEUTRAL] 9154.
[CUSTOMER][NEUTRAL] OK, and the first uh member's ID is 1407264 M for Mary, L for Lima number 8.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh yeah, sure. Member's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] Um, sure, it's [PII]. Total amount is 175.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Uh yes, sure provider's name is uh [PII].
[AGENT][NEUTRAL] Alright, so I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] Claim number is 360.
[AGENT][NEUTRAL] 9065.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just let me documentate that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] OK, got it, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][POSITIVE] So yeah, we can proceed with the, with the next one.
[AGENT][NEUTRAL] OK, hold on one moment, I'm just noting this policy, OK.
[CUSTOMER][NEUTRAL] Whenever you're ready?
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] OK, and the next member's policy number?
[CUSTOMER][NEUTRAL] OK, it's um 02307426 M for Mary, L for Lima, number 8.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mhm. Member's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] Um, yeah, sure, it's [PII], total amount is 200 even and same provider.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] So for this one I'm showing we received the claim on [PII].
[AGENT][NEUTRAL] And that claim number is 360.
[AGENT][NEUTRAL] 9069.
[AGENT][NEUTRAL] And on [PII], this claim was also denied because office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm mm mm mm.
[AGENT][NEUTRAL] OK, and then the last number whenever you're ready.
[CUSTOMER][NEUTRAL] OK. Um, it's 01407264 ML8.
[AGENT][NEUTRAL] And the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] OK, member's name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Alright, and the date of service and total bill for the claim?
[CUSTOMER][NEUTRAL] This is for [PII]. Um, total amount is $475 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And same provider, right?
[CUSTOMER][NEUTRAL] Uh, yes, mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so this one has a few different um denial reasons. So we received the claim on [PII].
[AGENT][NEUTRAL] The claim number is 360.
[AGENT][NEUTRAL] 9059.
[AGENT][NEUTRAL] And on [PII], um, code 99212 was denied because office visits are not covered by the policy.
[AGENT][NEGATIVE] The other two calls were denied because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Mm, OK, let me documented that.
[CUSTOMER][NEGATIVE] Are not covered when performed.
[AGENT][NEUTRAL] Not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][POSITIVE] You're welcome. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Mm, no, I think that will be all. Is there any uh reference number that I can get?
[AGENT][NEUTRAL] So the call reference number for the entire call will be my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK, and your name is just to make sure, sorry.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, got it, thank you so much, [PII].
[AGENT][NEUTRAL] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] Mm, no, that will be all thank you so much.
[AGENT][POSITIVE] Alright, thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thank you, bye bye.
[CUSTOMER][NEUTRAL] Mm bye bye.