AccountId: 011433970860
ContactId: b075d9d1-0599-4dee-b7b4-3cbad0a8fca0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 198880 ms
Total Talk Time (AGENT): 71600 ms
Total Talk Time (CUSTOMER): 88811 ms
Interruptions: 2
Overall Sentiment: AGENT=0, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/b075d9d1-0599-4dee-b7b4-3cbad0a8fca0_20250507T16:33_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from Pros office seeking on claims. Mhm.
[AGENT][NEUTRAL] OK, I could check on the claim for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, callback number [PII], no extension number.
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So, the policy number is 0187869.
[AGENT][NEUTRAL] All right, one moment.
[AGENT][NEUTRAL] OK, I think uh I missed a digit in there, [PII], could you repeat that policy number, please?
[CUSTOMER][NEUTRAL] Sure, it's 0187869.
[AGENT][NEGATIVE] Yeah, uh, so we're missing a digit that's not quite long enough to be one of our policy numbers.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEGATIVE] There is a digit missing from that policy number, [PII]. It is not quite long enough.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, let me double check. It's 01897869.
[AGENT][NEUTRAL] Uh, OK, so there was a 9 in front of the 71 moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] So, the member's name is [PII].
[CUSTOMER][NEUTRAL] [PII] date of birth [PII].
[AGENT][NEUTRAL] Thank you for verifying that and then what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the bill amount is $145 even.
[AGENT][POSITIVE] OK, got it thank you one moment please.
[CUSTOMER][NEUTRAL] Uh, sure, [PII]. Actually just claim got the right states non-covered service as per the patient's current benefits plan. So kindly check why it does, uh, why it was not covered.
[AGENT][NEUTRAL] Sure, give me just a moment let me get that pulled up.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, yes, so we were unable to pay a benefit on this claim as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Office visits are not covered under the patient's plan.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So the patient is liable, right?
[AGENT][NEUTRAL] We don't say what is patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] Uh, it would be $35 after the primary process as a co-payment.
[AGENT][NEUTRAL] Right, we wouldn't be able to pay a benefit as office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just give me a second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][POSITIVE] OK, thank you very much and can I have the reference number?
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial, and today's date. Uh, so my last initial is [PII] Was there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] OK, thanks.
[CUSTOMER][POSITIVE] Uh, no, nothing else. That's it for today. Thank you very much for your assistance. OK.
[AGENT][POSITIVE] Alright, well thank, yeah, thanks for calling APL. Have a great rest of your day.