AccountId: 011433970860
ContactId: 8746151b-c712-4678-a4f1-8d0ea1aa43cc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 389790 ms
Total Talk Time (AGENT): 114167 ms
Total Talk Time (CUSTOMER): 92668 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/8746151b-c712-4678-a4f1-8d0ea1aa43cc_20250508T21:17_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APFL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, my name is [PII] first initial of class name is [PII] and [PII] calling from provider office looking for claim status.
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status, Mr. [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, the callback number is [PII]. Direct line, no extension.
[AGENT][NEUTRAL] Thank you. And may I have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Yes, the facility name is Legacy Orthopedic uh PLLC.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, the patient policy number is
[CUSTOMER][NEUTRAL] 0172710.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] Mm, OK. Um, it looks like that's not enough numbers. And, can you repeat the number one more time?
[CUSTOMER][NEUTRAL] 0172710.
[AGENT][NEUTRAL] OK, that's the number I got. It's missing a digit. Do you have the copy of the card?
[CUSTOMER][NEUTRAL] Just give me one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, yes, I have the card, COVID.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] And the member ID number is 01702710.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, the patient
[CUSTOMER][NEUTRAL] Patient's first name is [PII] and last name is [PII]. It's [PII]. And the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Data service is [PII] and the total charge amount is $390 even.
[AGENT][NEUTRAL] OK, [PII] for 390.
[CUSTOMER][NEUTRAL] Yes, $390 390.
[AGENT][NEUTRAL] OK, let me see if I can find this claim for you. And for the future, you can check claim status online through our website at [PII] and that's just optional. And bear with me just a minute, let me pull the copy of the EOB, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm still waiting on the copy to pull up, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so it looks like we received the claim on [PII], process [PII].
[AGENT][NEUTRAL] The claim was denied. The reason for the denial is that office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] So the office visit is not covered under the patient policy?
[AGENT][NEUTRAL] Correct, office services are not covered under the member's plan.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And what's the member plan name?
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] Secondary supplement plan.
[AGENT][NEUTRAL] Mhm. Right.
[CUSTOMER][NEUTRAL] OK. And what would be the claim number?
[AGENT][NEUTRAL] The claim number is 3579719.
[CUSTOMER][POSITIVE] OK. Thank you so much. And what would be the reference number for today's call?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, that's [PII] [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much for the information and thank you so much for assisting me. Have a great day and take care.
[AGENT][POSITIVE] You as well. Thank you for calling APL. Have a good day. Bye-bye.
[CUSTOMER][POSITIVE] Thank you so much. Goodbye.
[AGENT][NEUTRAL] Mhm.