AccountId: 011433970860
ContactId: 99e7aeba-30c3-4527-853d-7258f25c4f84
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 171970 ms
Total Talk Time (AGENT): 53413 ms
Total Talk Time (CUSTOMER): 62485 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/99e7aeba-30c3-4527-853d-7258f25c4f84_20250515T19:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. I'm calling to check claim details.
[AGENT][NEUTRAL] OK, I can help you with claim status. Do you have, um, can I get your name and a good callback number?
[CUSTOMER][NEUTRAL] My name is [PII], that's [PII] Last initial [PII]. Callback number is [PII]. Direct line.
[AGENT][NEUTRAL] OK, and do you have the policy number for the patient?
[CUSTOMER][NEUTRAL] Yes, it's 02559295.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII], date of birth, [PII].
[AGENT][NEUTRAL] And date of service and bill charges.
[CUSTOMER][NEUTRAL] [PII] total bill amount is $680 even.
[AGENT][NEUTRAL] Uh, looks like we received it 326-25 and 2 I'm sorry, 226 25, 22825.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Um, office visits are not covered under the policy.
[AGENT][NEUTRAL] And then the other two charges, it's benefits are only payable if major medical insurance um provides benefits.
[CUSTOMER][NEUTRAL] OK, so is this a limited plan that's why this is not covered?
[AGENT][NEUTRAL] Yeah, it's a secondary like gap plan, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, give me one second.
[CUSTOMER][NEGATIVE] OK, so, OK, you guys denied it, it won't pay. This is a limited plan, um, did you guys?
[CUSTOMER][NEUTRAL] Apply any contractual adjustments or is the remaining $100 applied to the member's responsibility?
[AGENT][NEUTRAL] Um, we don't have a network, so there's no contractual adjustments, and then we can't, um, instruct on patient responsibility because it is a secondary policy.
[CUSTOMER][NEUTRAL] OK, got you. Can I have a reference number please?
[AGENT][NEUTRAL] Yes, reference number is my name, [PII] last [PII], [PII], and today's date. Anything else I can help with?
[CUSTOMER][NEUTRAL] Uh, [PII] today's date, correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, that's all thank you have a nice day.
[AGENT][POSITIVE] Thank you, you too.