AccountId: 011433970860
ContactId: 8ece68cb-173e-4ed3-be78-c0e5a18463b0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 403529 ms
Total Talk Time (AGENT): 106490 ms
Total Talk Time (CUSTOMER): 83291 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/8ece68cb-173e-4ed3-be78-c0e5a18463b0_20250617T14:05_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Rena Group of [PII], and I was just calling to check to see if you guys have a claim for a member.
[AGENT][NEUTRAL] OK. How do you spell your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you have their policy number?
[CUSTOMER][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] Her policy num, his policy number.
[CUSTOMER][NEUTRAL] 01423563
[AGENT][NEUTRAL] Thank you, [PII]. Hold on one moment, please.
[CUSTOMER][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And can I verify the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And you were calling about a claim status?
[CUSTOMER][NEUTRAL] Yes, he has 3 outstanding claims.
[AGENT][NEUTRAL] OK, I can look those up for you. What's the first date of service?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And what's the bill amount?
[CUSTOMER][NEUTRAL] $2700 even.
[AGENT][NEUTRAL] And what's one of the procedure codes that's on that bill?
[CUSTOMER][NEUTRAL] J as in Jack 9035
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, we did get that claim. It was denied. Office visits or anything done in a doctor's office is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So even the drug codes are not covered?
[AGENT][NEUTRAL] Nothing in the doctor's office is covered.
[CUSTOMER][NEUTRAL] OK. Is there a claim number?
[AGENT][NEUTRAL] It is 3602122.
[CUSTOMER][NEUTRAL] Is there a date that was denied.
[AGENT][NEUTRAL] Hold on just a moment, I can tell you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 5 1525.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have another data service?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] It would be the same thing. Nothing in a doctor's office is covered.
[CUSTOMER][NEUTRAL] OK, is there a claim number?
[AGENT][NEUTRAL] 3602118
[CUSTOMER][NEUTRAL] Is that 31s or 21s?
[AGENT][NEUTRAL] 2 1s
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The same denial date?
[AGENT][NEUTRAL] Hold on just a moment, I'll check.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, ma'am. 5:15, 25.
[CUSTOMER][NEUTRAL] OK. And the last one is [PII].
[AGENT][NEUTRAL] It would be for the same reason, um.
[AGENT][NEUTRAL] What was the total bill charge on that one?
[CUSTOMER][NEUTRAL] 11,040 books.
[AGENT][NEUTRAL] And what's one of the codes on that?
[CUSTOMER][NEUTRAL] Uh, let me see.
[CUSTOMER][NEUTRAL] It's gonna be J as in Jack 0178.
[AGENT][NEUTRAL] It would be for the same reason. Nothing in the doctor's office is covered.
[AGENT][NEUTRAL] The claim number is 3607628.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it was done on [PII]:30 25.
[CUSTOMER][NEUTRAL] OK. Is there an initial to your last name?
[AGENT][NEUTRAL] My initial is [PII].
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, is there a reference number or just today's date?
[AGENT][NEUTRAL] We do not have reference numbers you can use my name in today's date.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you, [PII] for calling APL. You have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye-bye.