AccountId: 011433970860
ContactId: 8b5d47f6-32e8-4e34-982e-4ec773992a13
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 687099 ms
Total Talk Time (AGENT): 124036 ms
Total Talk Time (CUSTOMER): 135140 ms
Interruptions: 3
Overall Sentiment: AGENT=1.2, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/8b5d47f6-32e8-4e34-982e-4ec773992a13_20250609T16:24_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. This is [PII] talking to you from provider's office, checking for claim status.
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] May I have
[CUSTOMER][NEUTRAL] Uh sure. Callback number is [PII] and it's a direct line. There is no extension.
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, sure. M's policy number is gonna be 10605184.
[CUSTOMER][NEUTRAL] M as in Mike, L as in Lima, number 7.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] I think I got too many numbers. Can you repeat that number?
[CUSTOMER][NEUTRAL] Sure. My name is uh [PII] and the date of birth is [PII]. OK.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Mm mm. No.
[AGENT][NEUTRAL] No, no, no, Mr. [PII], I was asking for the policy number again.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so sorry. Uh, the policy number ID is 10605184 M as in Mike, L as in Lima, number 7.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hm, OK, I got too many numbers on that number. Is it 01 instead of 10?
[CUSTOMER][NEUTRAL] 10 for understand.
[AGENT][NEUTRAL] 10, yeah, then I have too many numbers. Do you have the copy of the card?
[CUSTOMER][NEUTRAL] Let me double check. Just give me one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah, I do have it.
[AGENT][NEUTRAL] OK. What's the number on the card?
[CUSTOMER][NEUTRAL] Just give me one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 00, actually, it's uh starts with [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] What's the name and date of birth?
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] Member's name is [PII]. Date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the date of service and the amount of the claim?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] A date of service for the claim is from [PII] with the total amount of $15,546 and even.
[AGENT][NEUTRAL] OK, [PII] amount $15,546 even. Is that correct?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 5
[CUSTOMER][POSITIVE] Yeah, that's correct.
[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. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Just.
[AGENT][NEUTRAL] I'm waiting on the EOB to pull up.
[CUSTOMER][POSITIVE] For sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, it looks like we processed the claim on [PII] and the claim was denied. The reason for this denial is the benefits payable under the certificates are limited to those outlined on the scheduled benefits. This is not a cover loss under the plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] er.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh, OK. And uh can you fax me that copy of EOB because we haven't received.
[AGENT][NEUTRAL] Mhm. What is the fax number?
[CUSTOMER][NEUTRAL] Fax number is [PII].
[AGENT][NEUTRAL] OK, [PII], to what attention?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] [PII], OK, do you mind holding for me while I send this out to you while I got you on the line.
[CUSTOMER][NEUTRAL] Uh sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. OK, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, and actually, uh, you said the, the, the services are not covered under the patient's plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, so can we bill the balance to the patient?
[AGENT][NEUTRAL] It's up to the provider's discretion. We don't have any contractual involvement in the remaining.
[CUSTOMER][POSITIVE] OK, I just need the call reference number. That's what I have with me for the day. Thank you so much for your assistance.
[AGENT][NEUTRAL] OK, you're welcome and thank you for calling APO. Have a good day, Mr. [PII]. You can use my name in today's date. We don't have reference numbers, OK?
[CUSTOMER][POSITIVE] OK, got it. Thank you so much for your assistance. Bye for now. Take care.
[AGENT][POSITIVE] You as well. Thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah.