AccountId: 011433970860
ContactId: 937278c9-6965-47d1-b5b5-d038a8b65d76
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 271059 ms
Total Talk Time (AGENT): 87848 ms
Total Talk Time (CUSTOMER): 46679 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/937278c9-6965-47d1-b5b5-d038a8b65d76_20250422T19:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] I just need to verify a claim status.
[AGENT][NEUTRAL] Of course, I can help you with claim status today. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, 02230092.
[AGENT][POSITIVE] Oh, perfect. Thank you.
[AGENT][NEUTRAL] OK. And then can I get your name and a good callback number?
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] My callback number is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then what's the patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], um, [PII].
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK. And then do you have a claim number or?
[CUSTOMER][NEUTRAL] I do not, but the data service is [PII], 2024.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK, and then what's the charge amount?
[CUSTOMER][NEUTRAL] $38.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I found the claim number, just one moment.
[AGENT][NEUTRAL] OK, so it looks like the received date is [PII]. The process date is [PII].
[AGENT][NEUTRAL] And then what provider's office are you calling from?
[CUSTOMER][NEUTRAL] Uh, the Edward W. Sparrow Hospital.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, and then it looks like this claim was denied.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] It says benefits payable under the 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 what was that claim number?
[AGENT][NEUTRAL] It's 354.
[AGENT][NEUTRAL] 3459.
[CUSTOMER][NEUTRAL] And is there any way you can fax that to me because we don't have it posted in our system.
[AGENT][NEUTRAL] Yeah, of course.
[AGENT][NEUTRAL] What is your fax number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you. And then I can get that faxed right over to you. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Uh, just a call reference number.
[AGENT][NEUTRAL] Yeah, it's my first name, [PII]
[AGENT][NEUTRAL] Last initial [PII] and today's date.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] Yeah, you're welcome. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You as well bye.
[AGENT][NEUTRAL] OK, thanks. Bye.