AccountId: 011433970860
ContactId: 9ec8057b-f681-475e-8584-8d13f9d84d74
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 259290 ms
Total Talk Time (AGENT): 133433 ms
Total Talk Time (CUSTOMER): 80613 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/9ec8057b-f681-475e-8584-8d13f9d84d74_20250314T13:27_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from our office to check on the client status. Please be informed that this call is being recorded and monitored for quality and training purpose. How are you doing today?
[AGENT][POSITIVE] I'm doing great. [PII], go ahead and give me a good policy number.
[CUSTOMER][NEUTRAL] Yes, that's one moment. That's 02455394.
[AGENT][POSITIVE] All right, [PII], thank you so much for that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number.
[CUSTOMER][NEUTRAL] That's [PII] with no extension. It's a direct line.
[AGENT][NEUTRAL] It was [PII] and what was after that then? I'm sorry.
[CUSTOMER][NEUTRAL] OK, that's OK. Let me repeat it once again. That's [PII] and it's a direct line with no extension.
[AGENT][NEUTRAL] No.
[AGENT][POSITIVE] Alrighty, [PII], thanks so much for all the information. Now, what's your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] That looks like he is the insured on this medical supplemental plan, and you did say you want to check the status of a claim. Is that correct, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Now the service placer.
[CUSTOMER][NEUTRAL] The date of service is [PII], with the total charge amount of $292.04.
[AGENT][NEUTRAL] 29404, let's see, looks like I do see that claim for 1218. Now they do not have any type of coverage for anything done in the office at all. So that claim is being denied.
[AGENT][NEUTRAL] You want that claim number?
[CUSTOMER][NEUTRAL] OK, can I get the patience?
[CUSTOMER][NEUTRAL] Oh, yes.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Please go ahead with the claim number.
[AGENT][NEUTRAL] Yeah, claim number 3551773.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, may I know when it got denied?
[AGENT][NEUTRAL] I'm sorry, what was that being?
[CUSTOMER][NEUTRAL] May I know when the claim was denied?
[AGENT][NEUTRAL] You want to know when it was denied or why?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] Yeah, it's denied because they don't have any type of benefits here for office visits at all. Nothing in the office is covered here.
[CUSTOMER][NEUTRAL] OK. Can I get the patient's policy effective date and time and date?
[AGENT][NEUTRAL] Let's see. Effective date is [PII], terminated [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. So just to confirm the claim is not covered under Medicare, I mean, provider, right?
[AGENT][NEGATIVE] That is, not covered.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Um, may I know the claim process date?
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] Thank you. Uh, could you please spell your name once for my documentation purpose?
[AGENT][NEUTRAL] I sure can be and my name is spelled [PII] yes. And is that all I can help you with today?
[CUSTOMER][NEUTRAL] Thank you. Uh, can I get the mailing address just for my documentation purpose?
[AGENT][NEUTRAL] And I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Can I get the mailing address just for my documentation purpose?
[AGENT][NEUTRAL] The mailing address here?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, it is to APL claims department.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] We're in [PII].
[AGENT][NEUTRAL] And our zip is [PII].
[CUSTOMER][NEUTRAL] Thank you. And may I know the timely filing limit?
[AGENT][NEGATIVE] We do not have a timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get the reference number for our call?
[AGENT][NEUTRAL] We do not give reference number be, but you can use my name in today's date, OK?
[CUSTOMER][POSITIVE] OK. Thank you, love. Thank you for assisting and have a good rest of your day.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] Well, you as well, [PII]. Thanks for calling APL. Have a great Friday. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. Happy weekend. Bye-bye.