AccountId: 011433970860
ContactId: a727a233-0695-4a74-b882-c84a0552d5af
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 236979 ms
Total Talk Time (AGENT): 80192 ms
Total Talk Time (CUSTOMER): 85632 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/a727a233-0695-4a74-b882-c84a0552d5af_20250506T12:34_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] Hello, good morning, ma'am. My name is [PII] and I'm calling from the provider's office and I'm looking for the claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, [PII]. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Only one. Can you spell, spell your name?
[AGENT][NEUTRAL] My name is [PII] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And may I have a good
[CUSTOMER][NEUTRAL] No, only 1.
[AGENT][NEUTRAL] May I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Um, my callback number is [PII].
[CUSTOMER][NEUTRAL] And um the policy number is 02136350. 02136350.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] First name is [PII], and last name is [PII], and date of birth is uh [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 and the total bill for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Uh, the total, the total, some, uh, sorry, the data service is [PII] and the total charge amount is $263.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Mm forefront dermatology.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Forefront dermatology.
[AGENT][NEUTRAL] I'm showing that the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 359.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 4188.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered on this policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Of it is not.
[AGENT][NEUTRAL] Office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] So, ma'am, it is the members uh uh uh it is a non-go in the member's plan or the provider's plan.
[AGENT][NEUTRAL] The member's policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a second, ma'am.
[CUSTOMER][NEUTRAL] OK. And, uh, can you give me the call now?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name on today's date. First initial of my last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] All right. You're welcome, [PII]. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Ma'am, I, I just want to ask you that, uh, is this, uh, does this number have any other insurances left at tertiary?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Ma'am, does this member have any other insurance left?
[CUSTOMER][NEUTRAL] Except to primary.
[AGENT][NEUTRAL] Um, if he, if the member has other insurance, you'll have to check with them. All we know is United Healthcare because our policy is second to UnitedHealthcare.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you.