AccountId: 011433970860
ContactId: 93385b0c-ed45-4db2-8d07-9d983f594ede
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 290579 ms
Total Talk Time (AGENT): 75077 ms
Total Talk Time (CUSTOMER): 88323 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/93385b0c-ed45-4db2-8d07-9d983f594ede_20250425T19:08_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from provider's office looking for claim status.
[AGENT][NEUTRAL] OK, I'm happy to check claim status. Can I get the patient's policy number?
[CUSTOMER][NEUTRAL] Um, I know your good name. I didn't get that with you. I was on mute. Sorry for that.
[AGENT][NEUTRAL] Can I have the policy number?
[CUSTOMER][NEUTRAL] Sure. The policy number is 01947017.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] So the patient's name, [PII] and the date of birth [PII].
[AGENT][NEUTRAL] And data service.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Build them out.
[CUSTOMER][NEUTRAL] $830 even.
[AGENT][NEUTRAL] OK. One moment.
[AGENT][NEUTRAL] So it looks like we did receive a claim for this state of service [PII].
[AGENT][NEUTRAL] Clame was denied on [PII].
[CUSTOMER][NEUTRAL] OK, there is no claim on.
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Can I get the claim number?
[AGENT][NEUTRAL] 357.
[AGENT][NEUTRAL] 3602.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And may I know the date of the claim?
[AGENT][NEUTRAL] Claim is received.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, may I know the reason for the denial?
[AGENT][NEGATIVE] Services are not covered when performed.
[AGENT][NEUTRAL] In a doctor's office or clinic?
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And office visits are not covered.
[CUSTOMER][NEUTRAL] As per members plan.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, can I get the member's plan? What was the member's plan? Like, is it HMO or PPO?
[AGENT][NEUTRAL] Neither. We're the secondary insurance. This is a Medlik plan.
[CUSTOMER][NEUTRAL] My link plan.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Can I get the effective date of this plan?
[AGENT][NEUTRAL] Effective date or excuse me, [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Got that.
[CUSTOMER][NEUTRAL] And as the members plan the services which we bill you cannot be covered, so the member is responsible for the entire bill amount right.
[AGENT][NEUTRAL] We can advise on patient responsibility, that's up to the provider facility.
[CUSTOMER][NEUTRAL] OK, sure, let me talk to our team and once we can contact the member for more information. That's fine. Can I get the call reference?
[AGENT][NEUTRAL] Call reference is my name with my last initial and today's date. My name again is [PII], which is [PII], and then today's date.
[CUSTOMER][POSITIVE] Thank you, sir. Thank you very much for that and that's it for now. I got the information which I require pleasure talking to you. Have a great rest of your day, [PII].
[AGENT][NEUTRAL] You too. Bye-bye.