AccountId: 011433970860
ContactId: 95c2a158-3331-4905-9120-3b9f857d5d49
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 324130 ms
Total Talk Time (AGENT): 122768 ms
Total Talk Time (CUSTOMER): 94875 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/95c2a158-3331-4905-9120-3b9f857d5d49_20250326T16:49_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from Provada's office to check on claim status. How are you doing today?
[AGENT][NEUTRAL] I'm good, [PII]. And so you said that you, and how are you?
[CUSTOMER][POSITIVE] I'm fine, thanks a lot for asking that.
[AGENT][NEUTRAL] Good. Um, and so you're needing to check claims?
[CUSTOMER][NEUTRAL] Yeah, I'm checking on claims.
[AGENT][NEUTRAL] Yes, sir. I can help you with that. And what is the, your callback number, [PII]?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] The callback number will be [PII].
[AGENT][NEUTRAL] Thank you. And days, how many claims do you have to check status on?
[CUSTOMER][NEUTRAL] Uh, just one claim.
[AGENT][NEUTRAL] OK, and what is that member's policy number, please?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] And that'll be 01755430.
[CUSTOMER][NEUTRAL] ML 7.
[AGENT][NEUTRAL] OK, thank you. Give me just a couple of moments please to get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information day that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your pay.
[AGENT][NEUTRAL] Patient's name and their date of birth.
[CUSTOMER][NEUTRAL] That'll be [PII] or less. Date of birth will be [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what is the date of service and total bill amount for him please?
[CUSTOMER][NEUTRAL] That is [PII]. Total amount is $191 even.
[AGENT][NEUTRAL] 191. Is that correct?
[CUSTOMER][POSITIVE] Yes. Yes, you're right.
[AGENT][POSITIVE] OK, thank you. OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so this claim was received [PII] on [PII].
[AGENT][NEUTRAL] It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] The claim number is 353.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 2041.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the reason for the denial is office visits are not covered by the above numbered policy.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] The member's plan doesn't cover office visits, [PII].
[CUSTOMER][NEUTRAL] Oh, so you mean to say that offer visit visit are not covered under the patient plan, am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that is patient responsibility the balance of 62.61. Am I right?
[AGENT][NEUTRAL] We do not determine patient responsibility, [PII], that would be up to the provider.
[CUSTOMER][POSITIVE] OK. Thanks a lot for that information. And uh
[AGENT][NEUTRAL] You're welcome. And if you need a copy of this explanation of benefits, [PII], you may print that by going to our portal at [PII].
[CUSTOMER][NEUTRAL] Yeah, I do have the other thing.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] OK. Thanks a lot for that information. And I missed out your name. Could you give that again to me?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And you would use my name along with today's date as your call reference number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thanks a lot for that information. I really appreciate that. And you have a great day ahead.
[AGENT][NEUTRAL] Well, you're very
[CUSTOMER][POSITIVE] Take care. Bye-bye.
[AGENT][NEUTRAL] OK, is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Uh, nothing else, nothing else. I really appreciate it.
[AGENT][POSITIVE] Well you're certainly very welcome and thank you again for calling APL.
[CUSTOMER][NEUTRAL] OK.