AccountId: 011433970860
ContactId: 87622e0e-edc7-46bb-bc8d-80f56527a694
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 214600 ms
Total Talk Time (AGENT): 100045 ms
Total Talk Time (CUSTOMER): 28987 ms
Interruptions: 0
Overall Sentiment: AGENT=2.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/87622e0e-edc7-46bb-bc8d-80f56527a694_20250306T20:23_UTC.wav
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[AGENT][POSITIVE] Good. Thank you for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I need you to check claim status for a patient.
[AGENT][NEUTRAL] OK, you have one patient you're needing claim status for, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and who am I speaking with today please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Thank you and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] 02097331
[AGENT][NEUTRAL] OK, thank you, [PII]. Give me a couple of moments please to get the member's information pulled up.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Uh, you're welcome.
[AGENT][NEUTRAL] And then the information [PII] that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII] the [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for him please [PII]?
[CUSTOMER][NEUTRAL] [PII] and $447.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, [PII] said this claim was received. The received date was [PII], and it was processed and denied on.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The claim number is 3559793.
[AGENT][NEUTRAL] And the reason for the denial states that benefits payable under this certificate are limited to those outlined on the schedule of benefits. This is not a covered loss under the plan. Therefore, no amount is payable for this expense.
[CUSTOMER][NEUTRAL] OK, and was an EOB sent out to us?
[AGENT][NEUTRAL] Uh yes ma'am, it was in [PII] you can also print that from our portal if you go to [PII].
[AGENT][NEUTRAL] You should be able to print a copy of that explanation of benefits as well.
[CUSTOMER][POSITIVE] OK perfect thank you.
[AGENT][POSITIVE] All right, well, you're certainly very welcome. So is there anything else that I can help you with this afternoon?
[CUSTOMER][NEUTRAL] Uh, no, that's it.
[AGENT][POSITIVE] Alright, well then, thank you for calling APL and I hope you have a very nice rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.