AccountId: 011433970860
ContactId: 96141c38-8d34-480d-855e-c7a862d58bca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 384579 ms
Total Talk Time (AGENT): 151318 ms
Total Talk Time (CUSTOMER): 82039 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/96141c38-8d34-480d-855e-c7a862d58bca_20250416T12:31_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.
[CUSTOMER][NEUTRAL] Good morning. My name is [PII]. Your last name initially is [PII], and I'm looking for claim status for a member. Can you please help me with this?
[AGENT][NEUTRAL] OK, did you say that your name is [PII]? Is that correct?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, and you're needing claim status for one member, is that correct?
[CUSTOMER][NEUTRAL] Uh, sorry?
[AGENT][NEUTRAL] Do you need claim status for one patient?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Yes, I can help you with that and [PII], what is a good callback number for you please?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] 2173.
[CUSTOMER][NEUTRAL] 604
[AGENT][NEUTRAL] Thank you one moment please while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And then the information that I do provide for you today, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Most welcome.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And what is the date of service and total bill amount for him, please?
[CUSTOMER][NEUTRAL] Date of service is of [PII] with the bill amount of $185.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] OK, so this claim was received on 42-2025.
[AGENT][NEUTRAL] It was processed on 47-2025.
[AGENT][NEUTRAL] The claim number is 358.
[AGENT][NEUTRAL] 5490.
[AGENT][POSITIVE] And there was a benefit paid in the amount of 2 cents.
[AGENT][NEUTRAL] 0.02 cents.
[AGENT][NEUTRAL] That was on code.
[AGENT][NEUTRAL] 358 5, I'm sorry, that was on uh procedure G 2211.
[AGENT][NEUTRAL] And the 99214 was denied.
[AGENT][NEUTRAL] And the reason for the denial on that claim?
[AGENT][NEUTRAL] States that visits are not covered by this policy. The member's plan does not cover office visits.
[AGENT][NEUTRAL] [PII], are you still there?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Uh, can you please go with the payment information?
[AGENT][NEUTRAL] So the benefit was the issued amount of 2 cents was issued on check number.
[AGENT][NEUTRAL] 203.
[AGENT][NEUTRAL] 7464.
[CUSTOMER][NEUTRAL] And uh it is issued on?
[AGENT][NEUTRAL] The same date as the process date?
[CUSTOMER][NEUTRAL] OK. Uh, and, uh, it, it is a single payment check or bulk check?
[AGENT][NEUTRAL] We only have single check.
[CUSTOMER][NEUTRAL] OK. Thank you for, and it is cash or not?
[AGENT][NEUTRAL] Yeah, it is not as of now.
[CUSTOMER][POSITIVE] OK. Thank you for this information, ma'am. Uh,
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And if you need a copy of this.
[CUSTOMER][NEUTRAL] Can, uh, can you please go with?
[AGENT][NEUTRAL] If you need a copy of this exclamation of benefits, you may print that by going to our portal. Now that you have the claim number and our portal website is secured. [PII].
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there any
[CUSTOMER][NEUTRAL] Uh, thank you for this information. And your last name initially.
[AGENT][NEUTRAL] [PII], and my name in today's date will be your call reference number.
[CUSTOMER][NEUTRAL] OK. Thank you for this information, ma'am. I completed my and uh you have, uh, sorry for interrupting. Uh, you have any uh
[CUSTOMER][NEUTRAL] Policy guideline that this is not covered 99214.
[AGENT][NEUTRAL] This supplemental policy, the members supplemental policy does not cover office visits.
[CUSTOMER][POSITIVE] No worries. Thank you for this.
[AGENT][POSITIVE] OK, is there anything else I can help you with? You're welcome.
[CUSTOMER][POSITIVE] Thank you for this information, ma'am.
[CUSTOMER][NEUTRAL] No, thank you. Bye-bye for now.
[AGENT][POSITIVE] OK. Well, thank you for calling APL and I hope you have a nice day, [PII].
[CUSTOMER][NEUTRAL] Bye-bye. Same here.
[AGENT][NEUTRAL] Bye bye.