AccountId: 011433970860
ContactId: 97c293d0-f3f8-44f8-81cc-4bc2b2f85d13
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 258779 ms
Total Talk Time (AGENT): 101671 ms
Total Talk Time (CUSTOMER): 105218 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/97c293d0-f3f8-44f8-81cc-4bc2b2f85d13_20250512T16:52_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from provider office. I'm checking for the claim status. Can you please spell your name?
[AGENT][NEUTRAL] Sure, it's [PII], and I apologize your name.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, my name is [PII].
[AGENT][NEUTRAL] Uh, spell that one more time. [PII]
[CUSTOMER][NEUTRAL] Uh, yes, I'll repeat it again. [PII].
[AGENT][POSITIVE] OK, thank you and pronounce your name again [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Yes, [PII], yes, exactly.
[AGENT][NEUTRAL] OK, and what is that policy number, please?
[CUSTOMER][NEUTRAL] Yes, sure. Just a minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, the policy number is uh it is 02486627 M as in Mike, L as in Lima, number 8.
[AGENT][POSITIVE] OK, thank you so much. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, I do have that. It is [PII] at direct line.
[AGENT][NEUTRAL] Thank you and verify the patient's name, date of birth, please.
[CUSTOMER][NEUTRAL] Yes, sure.
[CUSTOMER][POSITIVE] Just a minute. Sorry for that.
[AGENT][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] Yes. The member name is, the first name is, it is [PII] and the last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you and you say you're calling about claim status correct?
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] Uh, what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] Yeah, the date of services, it is [PII] and the total charge is $241 even.
[AGENT][NEUTRAL] OK, thank you. And you're calling from?
[CUSTOMER][NEUTRAL] Holy Cross Medical Group.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And while I'm looking up claim information just to let you know we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I show this claim processed as office visits are not covered per the policy.
[CUSTOMER][NEUTRAL] OK. Our claim when it was received?
[AGENT][NEUTRAL] Uh, let me a moment. Uh, show the claim received [PII], processed on [PII].
[CUSTOMER][NEUTRAL] Oh is John [PII], like denied as uh the provider is office uh month, uh, the place of services office visit, so they are not covering, right?
[AGENT][NEUTRAL] Correct. The claim processes office visits are not covered per the policy.
[CUSTOMER][NEUTRAL] Please, uh, can you please tell me that again? Sorry for that. I'm doing documentation.
[AGENT][NEUTRAL] No, you're fine. The claim process as office visits are not covered per the policy.
[CUSTOMER][NEUTRAL] Of visit it.
[CUSTOMER][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] For the policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Got it. Can I get the claim number?
[AGENT][NEUTRAL] Yes, ma'am. It's 3589912.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'll repeat it again. 3589982, sorry, 9912, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, got it. The claim got denied, right?
[AGENT][NEUTRAL] Yes, as office visits are not covered per the policy.
[CUSTOMER][NEUTRAL] OK. Got it, got it, uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Thank you for giving the required information. Can I get a reference number for this call?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. However, if you like, you may use my name in today's date.
[CUSTOMER][POSITIVE] Sure, got it. Thank you for giving that required information. Take care. Bye-bye.
[AGENT][POSITIVE] Alright, you're welcome. Thank you for calling APL. Have a great rest of your day.
[CUSTOMER][POSITIVE] You you too bye bye.