AccountId: 011433970860
ContactId: 857eae25-6054-4bca-906f-93eacd7fca51
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 321230 ms
Total Talk Time (AGENT): 111291 ms
Total Talk Time (CUSTOMER): 102350 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/857eae25-6054-4bca-906f-93eacd7fca51_20250605T16:44_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] and I'm calling from provider's office. I'm looking for claim status.
[AGENT][NEUTRAL] OK, I could check on a claim for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Can you please spell out your name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You have that policy number?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK. So, uh yeah, policy number is
[CUSTOMER][NEUTRAL] uh, oh, sorry. Uh, give me one second, please. Let me open the policy number.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Just give me 1 2nd, please.
[AGENT][NEUTRAL] Sure, you're fine.
[CUSTOMER][NEUTRAL] Yeah, it is X as in X-ray, J as in Juliet, G as in Golf, H as in
[CUSTOMER][NEUTRAL] Henry, 327302-01.
[AGENT][NEUTRAL] OK, so that's not one of our policy numbers, [PII], um, our policy numbers don't begin with letters like that, um, do you maybe have their social? I could search for them that way.
[CUSTOMER][NEUTRAL] OK. OK. Give me one second. Yeah. And the policy number is uh
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] 020
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 61385.
[AGENT][NEUTRAL] OK, thank you. uh what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Yeah, my name is uh [PII].
[AGENT][NEUTRAL] OK, do you have his date of birth?
[CUSTOMER][NEUTRAL] Yeah. Uh, date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that. OK, and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII]. And the claim was billed for $1,122.
[CUSTOMER][NEUTRAL] And 27 cents
[AGENT][POSITIVE] Got it thank you one moment.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] OK, so we did receive this claim [PII] we were unable to pay a benefit as our patient services are not covered under this policy.
[CUSTOMER][NEUTRAL] Sorry, can you please repeat again? What is the claim number?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah, claim number is 35.
[AGENT][NEUTRAL] 94545.
[CUSTOMER][NEUTRAL] 545
[AGENT][NEGATIVE] Yes, and we were unable to pay a benefit as outpatient services are not covered under this policy.
[CUSTOMER][NEUTRAL] OK, OK, so when it was denied?
[AGENT][NEUTRAL] Uh, one moment, let me get that.
[AGENT][NEUTRAL] OK, uh, so this claim was received [PII], and it was processed on [PII].
[CUSTOMER][NEUTRAL] OK, and it was denied as not covered due to of uh outpatient is um covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, can I, can you please, uh, can you please explain the, I mean, why it was, uh, denied, basically, uh, it was denied as not covered because, uh, outpatient services are not covered uh as per patient plan.
[AGENT][POSITIVE] Correct. That's correct.
[CUSTOMER][NEUTRAL] OK. Mhm.
[AGENT][NEUTRAL] If you'd like, can I can send you a copy of this EOB. Uh-huh.
[CUSTOMER][NEUTRAL] Give me 1 2nd, please.
[CUSTOMER][NEUTRAL] Mhm. Yes, please. Uh,
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] You can give me your fax number whenever you're ready.
[CUSTOMER][NEUTRAL] Give me one moment please.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, I'm gonna read that back to make sure I heard that correctly. That was [PII].
[CUSTOMER][POSITIVE] That's right. Mhm.
[AGENT][POSITIVE] Alright, I will go ahead and send that now. I should get it within about 10 minutes or so. Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] No, it's OK.
[AGENT][POSITIVE] Alright, well thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you. Have a good day. Just provide me the call reference number.
[AGENT][NEUTRAL] Oh sure, reference number would just be my first name, last initial, and today's date, uh, so my last initial is A.
[CUSTOMER][POSITIVE] OK. So, it's OK. Thank you. Thank you. Have a good day. Bye-bye.
[AGENT][POSITIVE] All right you too thank you bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.