AccountId: 011433970860
ContactId: 95dab05d-ff70-45a2-aa08-76d5d7d563c6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 297850 ms
Total Talk Time (AGENT): 130277 ms
Total Talk Time (CUSTOMER): 137855 ms
Interruptions: 11
Overall Sentiment: AGENT=2.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/95dab05d-ff70-45a2-aa08-76d5d7d563c6_20250115T14:18_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, good morning. This is [PII] calling from provider's office, Clams and IPA looking for claims.
[AGENT][NEUTRAL] OK, [PII], you're needing claim status, is that correct?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that, [PII], and what is your callback number?
[CUSTOMER][NEUTRAL] [PII] direct line no extension.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] So [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. And then how many claims do you have to check status on?
[CUSTOMER][NEUTRAL] OK thank you and then how many points do you have to check that? Only one.
[AGENT][NEUTRAL] OK, and what is that member's policy number, please?
[CUSTOMER][NEUTRAL] OK, and what is that policy number, please? One moment. The member's ID number is [PII].
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And any information that that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] I do provide free today via verification of benefits and not a guarantee your payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you
[AGENT][NEUTRAL] And what is the date of service and total bill amount for him, please, [PII]?
[CUSTOMER][NEUTRAL] Date of service is [PII] with a charge amount of $295 295 dollars.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][POSITIVE] OK thank you one moment. No worries, take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Can you also spell your name for me?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Initial to last name?
[AGENT][NEUTRAL] [PII]. My name in today's date will also be your call reference number.
[CUSTOMER][NEUTRAL] S as in Sierra. My name and today's date will also be your call reference number. OK.
[AGENT][NEUTRAL] OK, so this claim has been received. OK, I'm sorry, it has been received and one moment and I'll provide you the received date.
[CUSTOMER][NEUTRAL] OK, so this claim has been received. OK, I'm sorry, it has been received one moment and I'll pull on to the receive date.
[AGENT][NEUTRAL] This claim was received on [PII], processed and denied on [PII].
[CUSTOMER][NEUTRAL] This claim was received on [PII].
[CUSTOMER][NEGATIVE] OK, why this is denied.
[AGENT][NEUTRAL] Claim number claim number is 3543145 and the reason for the denial?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the reason for the denial.
[AGENT][NEUTRAL] Is that office visits are not covered by the above numbered policy.
[CUSTOMER][NEUTRAL] This
[AGENT][NEUTRAL] This supplemental policy, [PII] does not cover office visits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. So the office visits are not covered under patient plan.
[AGENT][NEUTRAL] And if you
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits, you may print that from our portal.
[CUSTOMER][NEUTRAL] That you may print that from our portal.
[AGENT][NEUTRAL] By going to secured.
[CUSTOMER][NEUTRAL] I go to [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Yes, so that is correct.
[CUSTOMER][NEUTRAL] OK. And what's the patient plan name?
[AGENT][NEUTRAL] Medlink
[AGENT][NEUTRAL] M E D L I N K supplemental.
[CUSTOMER][NEUTRAL] E D L I.
[CUSTOMER][NEUTRAL] Supplement.
[CUSTOMER][NEUTRAL] P P L D M E N T A. OK, thank you very much for that information. And the reference number is your name and today's date. Is that correct?
[AGENT][POSITIVE] Mm. You're welcome.
[AGENT][POSITIVE] Yes, [PII], that is correct.
[CUSTOMER][POSITIVE] OK. Thank you very much for that information, [PII]. Have a good day too.
[AGENT][POSITIVE] You're welcome. And can I help you, can I help you with anything else?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] OK, well then, thank you for calling APL also, and I hope you have a nice day as well.
[CUSTOMER][POSITIVE] You're welcome and I hope you have a nice day as well. Bye bye.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.