AccountId: 011433970860
ContactId: ad6336e9-38db-4a10-9acf-f7462dd4a3a7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 265959 ms
Total Talk Time (AGENT): 106193 ms
Total Talk Time (CUSTOMER): 106164 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/ad6336e9-38db-4a10-9acf-f7462dd4a3a7_20250521T21:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling from the provider's office regarding a claim.
[AGENT][NEUTRAL] OK, yeah, I can check on a claim for you. Can, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it'll be [PII].
[AGENT][NEUTRAL] Thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, it will be 0244.
[CUSTOMER][NEUTRAL] 654-7.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] [PII], that was uh [PII] or [PII], and it's at [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that and then uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] This one's gonna be $325 or $25 for $277.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so we did receive this claim, uh, here we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][NEGATIVE] This did not cover.
[CUSTOMER][NEUTRAL] Sunday coffee
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Excuse me. Um,
[AGENT][POSITIVE] Bless you.
[CUSTOMER][NEUTRAL] This policy here is this, that's OK, sorry, I was sneezy. Um, is this policy like a limited, is it a limited policy why it's not covered for office visit? I guess I'm trying to.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Sure, so this is their secondary medical policy. Um, it does have a specific, uh, of course as it that is it has its own policy as well, and for this one office visits are not covered.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] OK. Um, let me just put that down so I, I will let, I will relay that to the patient. Uh, can I get, uh, so, I mean, I'm assuming if you guys didn't cover this, that means patients responsible for that balance, correct?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] We don't say what is patient responsibility that would be up to the provider um I will say uh a lot of these policies are very different. Some do cover uh office visits. This one does not, however, this policy does have it to where treatment received in office could be covered. It's just nothing like a consultation or anything like that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Yeah, because it didn't show that patient was responsible for that. That's why it's like.
[CUSTOMER][NEUTRAL] What did you guys do, um, for your, do you guys have a portal to your site? What do you guys have a portal that can like pull uh EOBs to look at to as well?
[AGENT][NEUTRAL] You can um and I can give you that claim number if you need that so that you can locate it.
[CUSTOMER][POSITIVE] Yes. Yes, please.
[AGENT][NEUTRAL] Let me know when you're ready for that.
[CUSTOMER][POSITIVE] I am ready.
[AGENT][NEUTRAL] OK, that is 358-842-3.
[CUSTOMER][NEUTRAL] Wait, let's see. I have one here and I was trying to use it to pull up. Yeah, I have this one, the same one here, and I used to pull it up on your site and then it, it can't pull up the claim for some reason.
[AGENT][NEUTRAL] I can just send you the EOB if you'd like. Do you have a fax number?
[CUSTOMER][NEUTRAL] That's weird.
[CUSTOMER][NEUTRAL] Yes, please. Uh, fax number is
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know when you're ready.
[AGENT][POSITIVE] Yes, I'm ready.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm gonna read that back to make sure I heard that correctly. That was 843-792-184 excuse me, 1864.
[CUSTOMER][NEUTRAL] Yes, 1864 yep.
[AGENT][POSITIVE] Alrighty, I will go ahead and send that now. You should get it within about 10 minutes or so. And was there anything else I can help you with?
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] Just a reference number please.
[AGENT][NEUTRAL] Sure, that would be my first name, last initial, and today's date and so my name is spelled [PII] last initial is A.
[CUSTOMER][POSITIVE] Awesome. Thank you, [PII]. You have a good day.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Bye bye.