AccountId: 011433970860
ContactId: b5291574-15cb-49ae-85d5-795c9ce8b45e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 190259 ms
Total Talk Time (AGENT): 48488 ms
Total Talk Time (CUSTOMER): 62410 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/b5291574-15cb-49ae-85d5-795c9ce8b45e_20250421T17:18_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] For calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling on behalf of the provider's office to check claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Callback number [PII].
[CUSTOMER][NEUTRAL] It's a direct line.
[AGENT][NEUTRAL] The policy number of the patient?
[CUSTOMER][NEUTRAL] Uh, so the policy number I'm looking for.
[CUSTOMER][NEUTRAL] 02506213
[AGENT][NEUTRAL] The patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's last name, [PII]
[CUSTOMER][NEUTRAL] And first name [PII]
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have the date of service?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] State of service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Day of services number [PII]. It's bill amount $129.62.
[AGENT][NEUTRAL] Uh, we received the claim on 1-10-2025.
[AGENT][NEGATIVE] That was processed 113-2025, and it's not a covered benefit. Office visits are not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh. May I know which type of plan is it?
[AGENT][NEUTRAL] Um, this is a secondary policy, supplemental secondary.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Then, uh, why is not covered.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEGATIVE] Office office visits are not covered under this policy. They're just specifically not covered.
[CUSTOMER][NEGATIVE] But, uh, for the secondary, secondary also which it will not go.
[AGENT][NEUTRAL] Yeah, it's the office visits are not covered under the policy. It's it's not a covered service.
[CUSTOMER][NEUTRAL] OK. Um, may I know your name?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] OK, can I get a call reference number?
[AGENT][NEUTRAL] Uh, it's my name and today's date.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day.