AccountId: 011433970860
ContactId: 9a817cfb-5fa4-4adc-84c4-2c439d85b6eb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 200660 ms
Total Talk Time (AGENT): 74763 ms
Total Talk Time (CUSTOMER): 104003 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/9a817cfb-5fa4-4adc-84c4-2c439d85b6eb_20250311T13:05_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. My name is [PII]. I'm calling from Lexington Medical, calling to see if you could provide claim status for me, please.
[AGENT][NEUTRAL] I sure can help you with the claim status and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you. May I have the member's policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes ma'am, it is 01673469.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] Yes ma'am, it's [PII]. The total bill amount is $165 but it's a balance to you all for $85.
[AGENT][NEUTRAL] $85 OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] This is Lexington Neurology.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] Yes ma'am, thank you.
[AGENT][POSITIVE] You're welcome. OK, here we go.
[AGENT][NEUTRAL] So I'm showing we received the claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 353-3609.
[CUSTOMER][NEUTRAL] 353-3609 OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] Uh this is
[CUSTOMER][NEUTRAL] I figured that. OK, OK, and let me see, hopefully I can pull it up by the claim number because without the claim number seems like your portal didn't like to give any information.
[AGENT][NEUTRAL] I can, um, did you need like a copy of the explanation of benefits?
[CUSTOMER][NEUTRAL] Yeah, I, let me see if it's coming up. I, I put it, um, I'm on your portal, so I think it's gonna come up. Let's see, yeah, it just say, um, get in the file, so we'll see what it gives me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Got it. OK.
[CUSTOMER][NEUTRAL] Uh, come on, come on, start and download, see, OK.
[CUSTOMER][NEUTRAL] Give me one second, Ms. [PII]. I think it's, it's working, it's thinking over here.
[AGENT][POSITIVE] Mhm. Take your time.
[CUSTOMER][POSITIVE] Yeah, let's see, I think I do have it.
[CUSTOMER][POSITIVE] Yes, I got it.
[AGENT][NEUTRAL] You got it. OK. Well, was there anything else I can help you with? OK.
[CUSTOMER][POSITIVE] Yes, are you able to give me, oh, just a reference number I'm sorry, I didn't mean to cut you off.
[AGENT][NEUTRAL] Oh, no, you're fine. Um, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you one [PII] or two [PII].
[AGENT][NEUTRAL] 2
[CUSTOMER][POSITIVE] 2, OK, alright, thank you. I do appreciate your time, [PII].
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] You do the same thank you bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.