AccountId: 011433970860
ContactId: a7f0029f-3302-434a-868b-8ab88d6cb493
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 573919 ms
Total Talk Time (AGENT): 124962 ms
Total Talk Time (CUSTOMER): 164435 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/a7f0029f-3302-434a-868b-8ab88d6cb493_20250507T15:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the product's office. So I need a claim status.
[AGENT][POSITIVE] OK, I could check on the claim for you. um, I'm so sorry, what was your name please?
[CUSTOMER][NEUTRAL] [PII] It's [PII].
[AGENT][NEUTRAL] Got it. OK, just, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, the, uh, so before going to further this call is being now recorded quality and training purpose. Is it OK with you?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, the policy number is 02258742 M as in Mike L as in Lima 7.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Uh, yes, the member name is [PII] and the date of birth is
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Perfect, thank you for verifying that and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII] and then uh do you have that billed amount?
[CUSTOMER][NEUTRAL] Bill amount is $909 even.
[AGENT][POSITIVE] OK, got it thank you one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Vish, do you have the uh tax ID for this provider?
[CUSTOMER][NEUTRAL] Yes, the tax ID is [PII].
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, so I did find this claim. I appreciate your patience. So for this claim we were unable to pay a benefit as office visits are not covered under this policy. As for everything else, it looks like the insured's primary insurance uh provided full benefits, but there was nothing additional for us to pay.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, yes, but uh primary paid and it is forwarded to co-pay $15 to the secondary uh uh insurances, American Public Life Insurance. So, may I know the status?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Right, the only procedure code left that was 99214. Uh, we were unable to pay that benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, OK. So why not pay the office visit?
[AGENT][NEGATIVE] It is not covered under this policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so as I can see ENM code is pay.
[CUSTOMER][NEUTRAL] All the policies, so.
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so may I know the policy name under which policy?
[AGENT][NEUTRAL] Yes, this is their secondary medical policy.
[CUSTOMER][NEUTRAL] OK, just a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so can you please repeat again? You said the policy is not covered for the ENM code, right?
[AGENT][NEUTRAL] Right, office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so may I know your good name, please spell your name.
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] OK, [PII]. May I know the call reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh so my last initial is [PII] And was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Mm, yes, [PII]. I have uh another member.
[AGENT][NEUTRAL] A different claim for a different member, correct?
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] OK, yes, give me just a moment, uh, I'll let you know when I'm ready for that next one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, you can go ahead and give me that next policy number.
[CUSTOMER][NEUTRAL] OK, the next policy number is.
[CUSTOMER][NEUTRAL] 63 Y as in Yankee 0001808.
[AGENT][NEUTRAL] OK, that's not going to be one of our policy numbers. Uh, do you maybe have their social? I could search for them that way.
[CUSTOMER][NEUTRAL] Um, sorry, what did you say?
[AGENT][NEUTRAL] That's not one of our policy numbers. Do you have the member's social and I can search for them that way.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know, I have only uh member ID.
[CUSTOMER][NEUTRAL] So, uh, is it not your OK, so may I know.
[AGENT][NEUTRAL] OK, so that's not one of our policy numbers.
[CUSTOMER][NEUTRAL] So can you please forward my call for that department?
[AGENT][NEUTRAL] I, it's not a different department. That's not, that policy number is not with American Public Life.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So can you please search by the name member name and date of birth?
[AGENT][NEUTRAL] Yes, if you wouldn't, well, I wouldn't be able to use the date of birth, but if you would, uh, spell.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEGATIVE] Hello, you are not audible to me.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello, are you there?