AccountId: 011433970860
ContactId: 85f11473-d8db-4eb1-9229-03d7debf4077
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 942359 ms
Total Talk Time (AGENT): 176077 ms
Total Talk Time (CUSTOMER): 367074 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/85f11473-d8db-4eb1-9229-03d7debf4077_20250612T13:28_UTC.wav
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[AGENT][POSITIVE] Good morning thank you for calling.
[AGENT][NEUTRAL] For calling APL, my name is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. This is [PII] from provider's office. I want to know the claim status. Could you help me with that?
[AGENT][NEUTRAL] What is your name again?
[CUSTOMER][NEUTRAL] My name is [PII], that is [PII] And to my last name is [PII]. And what is your initial last name?
[AGENT][NEUTRAL] It is [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I, you're welcome. May I have your callback number?
[CUSTOMER][NEUTRAL] Sure, it is [PII] direct line.
[AGENT][POSITIVE] Thank you and that's of course if
[AGENT][NEUTRAL] We're disconnected. I'd have to call you back. And what is that policy number?
[CUSTOMER][NEUTRAL] Um, that is.
[CUSTOMER][NEUTRAL] 0197
[CUSTOMER][NEUTRAL] 2388 M as in Mike, L as in Lima, number 8.
[AGENT][POSITIVE] Thank
[AGENT][POSITIVE] Thank you so much. Let me just repeat that to you. I have that as 019.
[AGENT][NEUTRAL] 972-388 ML 8.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Thank you verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yeah, the patient is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you very much. And again, you're calling for claim status. I can assist you with this. You can also check claim status by visiting our secure portal at [PII].
[AGENT][NEUTRAL] [PII] and on that website you'll be able to obtain any EBM as well.
[AGENT][NEUTRAL] What is the date of service and the total charge amount, please?
[CUSTOMER][NEUTRAL] Um, yes, the service is, um, [PII] of this year, and the bill amount is 457.95. That is $457.95.
[AGENT][POSITIVE] OK thank you very much I appreciate that one moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEGATIVE] Now it shows that the claim was received and it denied. Give me one moment please to get that done another reason for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK thank you. Is that it denied as policy provides no benefits for the treatment of conditions other than a sickness or injury.
[CUSTOMER][NEUTRAL] OK. uh, first of all, can you just let me know the claim number?
[AGENT][NEUTRAL] Of course, it is 3607781.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, is it 3607781, right?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] All right. When it was received and uh denied?
[AGENT][NEUTRAL] Received on [PII] and denied on [PII].
[CUSTOMER][NEUTRAL] OK. And you said?
[CUSTOMER][NEUTRAL] Uh, it was non-covered on the patient plan or what was the actual reason?
[AGENT][NEUTRAL] OK, it was not uncovered for the patient's plan um benefits are covered for sickness or injury that shows that this is maybe a preventative.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Or wellness visit, which is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, let me check something quick here. OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, just give me a quick second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm OK.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] So, uh, is there any, uh, issue with the diagnostic code that we have built?
[AGENT][NEUTRAL] In regards to the policy, it pays for.
[AGENT][NEUTRAL] Benefits towards a sickness or an injury again this does not show this was due to a sickness or an injury which is why the claim was denied.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, [PII]. No problem. Uh 00, can you just, uh, do one thing? Can you just send me the your bill over to my email uh address so that I can, uh, you know, verify it.
[AGENT][NEUTRAL] Do you have a fax number?
[CUSTOMER][NEUTRAL] Yeah, I have a fax number but our fax is not working right now so it would be helpful for me if you can submit it to my email address.
[AGENT][NEUTRAL] You're able also to get that off the website at [PII].
[AGENT][NEUTRAL] [PII]. [PII]. Um, what is the email address to see if it's a secured email address?
[CUSTOMER][NEGATIVE] Oh no, I don't have the access.
[CUSTOMER][NEUTRAL] Sure. Uh, that is our, actually [PII] uh approved email address. That is uh [PII], that is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] I'm so sorry. [PII]?
[CUSTOMER][NEUTRAL] [PII]. Can you just give me a quick second?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, I'm sorry, uh, [PII]. Uh so the, um, it's [PII]. That is [PII] that is [PII]. Did you get it or do I have to repeat once again?
[AGENT][NEUTRAL] I have that. Anything else I can help you with, please, [PII]?
[CUSTOMER][NEUTRAL] Uh, nothing else. That's the only claim that I was having, uh, but, uh, have you sent it?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Have you seen the UB? Have you seen the YB?
[AGENT][NEUTRAL] I have not. I have not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can assist you with? You have another claim for me to check claim status for you?
[CUSTOMER][NEUTRAL] Nothing else, [PII]. That's the only claim, but I'm actually expecting the UV that's why if you can help me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You will receive the EOB today again, you are able to access the website at [PII], but I have not sent the EOB as of yet.
[AGENT][NEUTRAL] Um, anything else I can assist you with, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, nothing, you just provide me the reference number, and that's it.
[AGENT][NEUTRAL] We do not provide a reference numbers. You can use my name and today's date.
[CUSTOMER][NEUTRAL] All right. Uh, uh, [PII], I would like to ask one thing. Since I do not have the access on the web portal, uh, uh, can you help me to get through, uh, with the, uh, portal so that I can access?
[AGENT][NEUTRAL] I can try to assist you with that, [PII].
[AGENT][POSITIVE] OK, it is secured.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, let me just uh go through the portal first.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. It's uh [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] All right. So, uh, I am creating the OSC account, right?
[AGENT][NEUTRAL] Excuse me.
[AGENT][POSITIVE] Correct, as a provider.
[CUSTOMER][NEUTRAL] OK. Yeah, provided, then next. But uh it does not take the, uh, you know, the tax ID number. When I put [PII] and then hit next.
[CUSTOMER][NEUTRAL] Uh, completed account set up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. Yesterday, it was unable to uh go through, but today it has been uh gone through. OK.
[CUSTOMER][NEUTRAL] Uh, now, I have put my email ID.
[CUSTOMER][NEUTRAL] And send a verification code.
[AGENT][NEUTRAL] Can I place you on hold for just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, sorry about that.
[CUSTOMER][POSITIVE] No problem at all. I have actually created the account. I was about to log in the account. It has asked me to submit the verification code to my mail.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I am expecting an OTP.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] OK, now I have opened the dashboard.
[CUSTOMER][NEUTRAL] OK. And now, just I have to put the claim number that you have given me.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And just hit search. OK, I have to fill out all the details along with the claim number like the first name.
[CUSTOMER][NEUTRAL] OK. The first name?
[CUSTOMER][NEUTRAL] And the date of birth.
[CUSTOMER][NEUTRAL] Please provide the first name on record.
[CUSTOMER][NEUTRAL] Uh, why is, uh, why is it saying the member's first name is incorrect?
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] It's [PII]?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, let me check.
[CUSTOMER][NEUTRAL] This searching now.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Policy number has came through, confirmation number.
[CUSTOMER][NEUTRAL] That received checking UB. I believe that UB has not yet uh generated, right?
[AGENT][NEUTRAL] It has it was processed on.
[AGENT][NEUTRAL] [PII] so that you'll be has been generated.
[CUSTOMER][POSITIVE] OK, yes, yes, yes, it has been generated. I'm downloading it now.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] So that's wonderful. Yesterday, I was unable to log in, but today when I'm talking, I mean, when I uh uh I was speaking with you, it was absolutely done. I don't know how it first happened, but
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[CUSTOMER][POSITIVE] I feel so lucky with you.
[CUSTOMER][NEUTRAL] All right.
[AGENT][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] It was a miracle for me. Thank you so much, [PII], for your time today. You have a wonderful day. Stay safe and bye-bye. Happy weekend. Bye.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, and thank you for calling. You too, bye bye. Take care.