AccountId: 011433970860
ContactId: b492ad36-e9be-4072-8779-d291211280e1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 407760 ms
Total Talk Time (AGENT): 102863 ms
Total Talk Time (CUSTOMER): 116252 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/b492ad36-e9be-4072-8779-d291211280e1_20250611T17:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, this is [PII]. I wanted to know including status.
[AGENT][NEUTRAL] OK, I can help you with claim status and I missed your name. What was that?
[CUSTOMER][NEUTRAL] Needed [PII]
[AGENT][NEUTRAL] OK, [PII], and do you have the policy number for the patient?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] 147577
[CUSTOMER][NEUTRAL] 5 M as in Mike. L as in Lima, and then number 8.
[AGENT][NEUTRAL] And what is a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure, before I tell you that, just letting you know this call is being recorded for quality and training purpose, OK?
[CUSTOMER][NEUTRAL] And the first name is [PII].
[CUSTOMER][NEUTRAL] The last name is.
[CUSTOMER][NEUTRAL] [PII], I don't know how to pronounce that, and the date of birth is [PII].
[AGENT][NEUTRAL] Alright thank you and you said claim status or eligibility?
[CUSTOMER][NEUTRAL] Claim status.
[AGENT][NEUTRAL] And what were the date of service and bill charges?
[CUSTOMER][NEUTRAL] [PII] and the bill amount is $515 even.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, I don't show a claim on file. Can you resubmit?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] We had to send it on [PII].
[CUSTOMER][NEUTRAL] And it does show here on my system that it was
[CUSTOMER][NEUTRAL] Adjudicated on [PII].
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Oh, OK, this is the old plan number. Hold on one moment, let me get a new one.
[AGENT][NEUTRAL] OK, um, looks like, yes, we received the claim on [PII] process 4-24-2025.
[AGENT][NEUTRAL] Office visits are not covered under the policy.
[AGENT][NEUTRAL] And we needed a copy of the primary explanation of benefits.
[CUSTOMER][NEUTRAL] OK, so this plan doesn't cover the member's office visits?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you need primary you'll be, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And may I have the fax number?
[CUSTOMER][NEUTRAL] So that I can send it back.
[AGENT][NEUTRAL] Actually
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes. [PII].
[CUSTOMER][NEUTRAL] OK and uh may I have the claim number?
[AGENT][NEUTRAL] number 359-3663.
[CUSTOMER][NEUTRAL] And the call reference number?
[AGENT][NEUTRAL] My name is [PII] and today's date.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And the initial of your last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] Yeah, that will be all set and uh before I end the call, may I know if the plan doesn't cover office visits, uh, what kind of services does the plan covers in general?
[AGENT][NEUTRAL] And so you're needing benefits.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, um, give me just a moment.
[AGENT][NEUTRAL] Not a guarantee of payment, basic outline of the policy.
[AGENT][NEUTRAL] Um, it's cover
[AGENT][NEUTRAL] Covers outpatient hospital services.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Uh, per calendar day benefit of 250.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is that all?
[AGENT][NEUTRAL] Uh, it has inpatient coverage. Do you need inpatient and inpatient as well?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, inpatient calendar, your maximum coverage is 7900.
[CUSTOMER][NEUTRAL] on that
[AGENT][NEUTRAL] Then the maximum for the outpatient that it will pay is 2500.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] For calendar year.
[AGENT][NEUTRAL] And it does cover treatment rendered in the doctor's office, just not the office visit itself.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you, [PII] that will be all.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.