AccountId: 011433970860
ContactId: 892d3dd1-36b5-4c18-b4cf-b5da939914cd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 291279 ms
Total Talk Time (AGENT): 135504 ms
Total Talk Time (CUSTOMER): 90289 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/892d3dd1-36b5-4c18-b4cf-b5da939914cd_20250121T19:24_UTC.wav
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[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I was calling to get claim status.
[AGENT][POSITIVE] It would be my pleasure to assist you with claim status. May I ask your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, [PII]. And what is a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] It is 02129475.
[AGENT][NEUTRAL] And what is the patient's name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] I have [PII] [PII].
[AGENT][POSITIVE] Alright, thank you, and it would be my pleasure to assist you with that claim status. What is the date of service, please?
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Um, [PII] [PII] billed amount $230.
[AGENT][NEUTRAL] OK, bear with me just one moment. This policy actually turned on 12-123. Let me get the correct policy pulled up for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And we'll check it on that active policy.
[AGENT][POSITIVE] I'll give you the correct policy number as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. As of [PII], [PII]'s active policy number is 243.
[AGENT][NEUTRAL] 5576.
[CUSTOMER][NEUTRAL] OK, you said 243557-6?
[AGENT][NEUTRAL] That is correct. And that's as of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I do apologize for that data service 1028 24. What was that bill amount?
[CUSTOMER][NEUTRAL] Um, $230.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Looks like we might have received that claim twice. Let me go back to the original claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the provider name?
[AGENT][NEUTRAL] Facility name.
[CUSTOMER][NEUTRAL] Um, it's
[CUSTOMER][NEUTRAL] Test Regional Medical Center and I do see we do have uh we've sent out two claims for 1028 2024, so I'll need status on both of them actually.
[AGENT][POSITIVE] OK. Sure. I can help you with that.
[AGENT][NEUTRAL] So the original claim we received on [PII] and processed on [PII].
[AGENT][NEUTRAL] And that claim was denied as services are not covered when performed in a doctor's office.
[AGENT][NEUTRAL] And I can provide that claim number.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] The claim number is 354.
[AGENT][NEUTRAL] 8205.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then we received the, uh, duplicate claim on [PII].
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] And processed on [PII].
[AGENT][NEGATIVE] It was denied as a duplicate.
[CUSTOMER][NEUTRAL] OK, um, let me ask you, so for her policy, um, what kind of policy is this? We don't have a card on file, so I'm not really sure what she has.
[AGENT][NEUTRAL] It is a secondary gap policy, like a supplemental, secondary to her major major medical coverage.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But is the um doctor office or physician visit not covered?
[AGENT][NEUTRAL] That is correct. Services in a doctor's office are not covered under her plan.
[CUSTOMER][NEUTRAL] OK, um, got you. Let me see something.
[CUSTOMER][NEUTRAL] All right. All right, well then, um, I will just make note of that. Can I just have your name again and a reference number?
[AGENT][NEUTRAL] My name is [PII], and the reference number would be my name and today's date.
[AGENT][NEUTRAL] And is there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] All right, thank you
[CUSTOMER][NEUTRAL] No, ma'am, that was it.
[AGENT][POSITIVE] Well, thank you for calling APL and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Thank you. You as well.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm bye bye.