AccountId: 011433970860
ContactId: a750aae3-8601-4d29-a506-07494d5394cf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 244600 ms
Total Talk Time (AGENT): 87596 ms
Total Talk Time (CUSTOMER): 62948 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/a750aae3-8601-4d29-a506-07494d5394cf_20250529T18:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh yeah, hi, this is [PII] calling from provider's office regarding claim status.
[AGENT][NEUTRAL] I can help you with claim status. Can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Oh yeah, that is [PII].
[AGENT][NEUTRAL] And the policy number?
[CUSTOMER][NEUTRAL] Uh, but before we proceed, I would like to inform you this call is being recorded for training and quality purposes. So are you OK with it?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, thank you. Uh, policy number is 016471117.
[AGENT][NEUTRAL] Let me look that up for you.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Let me look that up for you, give me just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] Uh yeah, date of service is [PII].
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] OK, it looks like we received this claim on [PII].
[AGENT][NEUTRAL] This claim was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Of 2025?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 35.
[AGENT][NEUTRAL] 92
[AGENT][NEUTRAL] 312.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And it looks like this claim was denied.
[AGENT][NEUTRAL] Um, because the policy provides no benefits for the treatment of conditions other than a sickness or injury.
[CUSTOMER][NEUTRAL] Mm, that means it is non-covered?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] As per member plan?
[AGENT][NEUTRAL] Yeah, as written in their plan their plan only covers services if they are um sick or injured.
[CUSTOMER][NEUTRAL] If they are what?
[AGENT][NEUTRAL] Sick or injured?
[CUSTOMER][NEUTRAL] OK. So this is is like preventive?
[AGENT][NEUTRAL] Right, they would have, yeah.
[CUSTOMER][NEUTRAL] Uh, OK, no issues. Can I get the plan name?
[AGENT][NEUTRAL] The plan name?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It is a Medlink policy, Medlik SSS.
[CUSTOMER][NEUTRAL] OK, OK, uh, can I get the call reference?
[AGENT][NEUTRAL] So we don't have call reference numbers, but you can use my name in today's date, so [PII], in today's date.
[CUSTOMER][POSITIVE] OK. OK, then. Thank you so much. Have a great day.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEGATIVE] Nothing thank you.
[AGENT][POSITIVE] Alright, thank you for calling APL have a great day.
[CUSTOMER][NEUTRAL] Goodbye.