AccountId: 011433970860
ContactId: b695ba5d-c70f-4787-b998-ca1d74d24885
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 387250 ms
Total Talk Time (AGENT): 175911 ms
Total Talk Time (CUSTOMER): 133989 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/b695ba5d-c70f-4787-b998-ca1d74d24885_20250221T13:27_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, very good morning. My name is [PII] and I'm calling from the provider office, uh, looking for a claim status.
[AGENT][NEUTRAL] OK, you have one claim, [PII], that you're needing claim status on, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] It's a direct line [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] It's 971-103.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And any information [PII] that I provide for you today will be a verification of benefits and not a guarantee of payment. What is her date of birth?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] And you say uh your name is uh [PII]?
[AGENT][NEUTRAL] [PII] at the beginning.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the data service and total bill amount for her, please?
[CUSTOMER][NEUTRAL] OK, uh, date of service is for [PII].
[CUSTOMER][NEUTRAL] [PII] and to fill on let me see, let me double check OK it's 555 $50 even.
[AGENT][NEUTRAL] 550
[CUSTOMER][NEUTRAL] Yeah, 550.
[AGENT][NEUTRAL] And again the date of service is [PII].
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] OK, so [PII], this claim was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 354 excuse me, let me start that again. The claim number is 3,554,400.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the reason for the denial on this claim is one office visits are not covered.
[AGENT][NEUTRAL] By this policy?
[CUSTOMER][NEUTRAL] 10.
[AGENT][NEGATIVE] No, one of the, there's two denial reasons. The first one is office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK, office this is not covered by the policy.
[AGENT][NEUTRAL] Mhm. That is correct. And the other two codes state the remark as insured's primary insurance provided full benefits, there are no benefits payable.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, you said the second one is?
[AGENT][NEUTRAL] And if you need a
[AGENT][NEUTRAL] I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Can you repeat me?
[CUSTOMER][NEUTRAL] Uh, can you repeat me the second thing I read once again? I'm sorry, the benefits.
[AGENT][NEUTRAL] Insured primary insurance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Provided full benefits, there are no benefits payable.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits, [PII], you may print that now that you have the claim number by going to our portal at [PII].
[CUSTOMER][NEUTRAL] OK, you say, uh, [PII].
[AGENT][NEUTRAL] Mhm, with a D on it. So it is spelled [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK um
[CUSTOMER][NEUTRAL] Uh, [PII] OK, and uh for for this one, do, do we need to, do we need to, uh, lock in for this one?
[AGENT][POSITIVE] Yes sir, that's correct.
[AGENT][NEUTRAL] Yes sir, it's a self registering portal and then when you now that you have the claim number you should be able to print that explanation of benefits.
[CUSTOMER][NEUTRAL] Oh, I believe we don't have, we don't have a nexus uh.
[AGENT][NEUTRAL] Yes sir, you would have to set that up. Yes sir, you would set that up when you will just answer the questions when you go to that website.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK, alright, so we need to, we need to, um, we need to register for this one, right?
[AGENT][NEUTRAL] Yes, sir, you would self-register.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] Uh, claim number, OK, and, um, uh, for future reference, what is the timely filing limit to submit a claim?
[AGENT][NEUTRAL] There is no timely filing limit with our company?
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] OK, and uh what will be our call reference number for today, [PII]?
[AGENT][NEUTRAL] My, yes, sir, my name and today's date.
[CUSTOMER][NEUTRAL] Uh, what will be your last name initial?
[AGENT][NEUTRAL] S and yours?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] What is yours?
[CUSTOMER][NEUTRAL] It's also [PII], yeah, same as yours, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Same as mine, OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Alright, nice talking with you, [PII]. Enjoy the rest of the day that will be all for today. Mhm bye.
[AGENT][NEUTRAL] Oh, bye.
[AGENT][POSITIVE] OK, [PII]. Well, if that's all I can help you with, thank you again for calling APL and I hope you have a nice weekend.
[CUSTOMER][NEUTRAL] You do the same, mhm.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] But