AccountId: 011433970860
ContactId: b74b70dd-5ca8-4eec-bd50-f0ae08845945
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 609020 ms
Total Talk Time (AGENT): 133317 ms
Total Talk Time (CUSTOMER): 145061 ms
Interruptions: 2
Overall Sentiment: AGENT=-0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/b74b70dd-5ca8-4eec-bd50-f0ae08845945_20250325T19:52_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is how may I assist you?
[CUSTOMER][NEUTRAL] Yeah, hi, good afternoon. My name is [PII] calling from provider's office to check on our claims. Could you please spell your name?
[AGENT][NEUTRAL] Sure. My name is [PII]. That's [PII]. And may I have a callback number just in case we get disconnected and the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Callback number is [PII]. It's Summit Dermatology and SPAL.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 01660274 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] OK, you got, I got 01660. After that?
[CUSTOMER][NEUTRAL] OK. Let me reconfirm it again. It's 01660274 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, thank you. One moment, let me pull this information.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII]. Date of birth for [PII].
[AGENT][NEUTRAL] Um, that's not who I called.
[AGENT][NEUTRAL] Can you check that information again?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The patient's first and last name, it's [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Calculator
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEGATIVE] That's not the date of, that's not matching. The date of birth is not matching at all.
[CUSTOMER][NEUTRAL] [PII] is not matching.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] One second
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] There's the thing I do have here.
[AGENT][NEUTRAL] Yeah, that, that's not matching, so um the number probably needs to call us back to verify that information, but that's not matching at all.
[CUSTOMER][NEGATIVE] No, no, actually, we received a denial from this claim.
[AGENT][NEUTRAL] OK, what's the claim number?
[CUSTOMER][NEUTRAL] As in Octopus. Yeah, it's 357-316-5.
[AGENT][NEUTRAL] Bear with me.
[CUSTOMER][NEUTRAL] Could you please reconfirm the uh birth date again?
[AGENT][NEGATIVE] I cannot give you that information, but the information you're giving me is not correct.
[CUSTOMER][NEUTRAL] No, the one, the one which I have provided to you.
[AGENT][NEGATIVE] It's not correct.
[CUSTOMER][NEUTRAL] Yeah, repeat it again.
[AGENT][NEUTRAL] I didn't write it down. I'm looking into the policy. I'm looking into the date of birth and I'm looking at the information I have. It doesn't match the one you're giving me. Can you repeat the one you're giving me again?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEGATIVE] That's not matching at all.
[AGENT][NEGATIVE] It's not even close to what we have.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So [PII] is not what we have in the system.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Um 35757.
[AGENT][NEUTRAL] 5, let me put the image.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is your question about this claim?
[CUSTOMER][NEUTRAL] Checking on our claims.
[AGENT][NEUTRAL] Yes, what is your question because you already have the claim number, so what is your question for this claim?
[CUSTOMER][NEUTRAL] Yes, actually, yes, uh, I just see, uh, I think this has been denied as an office visit not covered by the above numbered policy.
[CUSTOMER][NEUTRAL] We received just this information. What it mean? I need to know the exact denial reason.
[AGENT][NEGATIVE] Office visits are not covered. It means office visits are not covered. There's not another explanation. It's just not covered under the policy.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Just give me a minute, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just give me a minute. May I please place your phone on hold for a minute, please?
[AGENT][NEUTRAL] Yeah, sure.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] So thank you so much for that information, ma'am.
[AGENT][POSITIVE] Welcome. Yes.
[CUSTOMER][NEUTRAL] Yes, uh, is it a limited, uh, policy?
[CUSTOMER][NEUTRAL] the
[AGENT][NEUTRAL] This policy is a secondary supplemental plan to the major medical and it does not cover office visit. It's not covered under the member's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][POSITIVE] Yeah, thank you so much for that information. Can I get a call reference for this call, please?
[AGENT][NEUTRAL] We don't have a reference numbers, you can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's [PII], right?
[AGENT][NEUTRAL] Yes, that's initial [PII].
[CUSTOMER][POSITIVE] Thank you so much. Thank you so much. So you have a great day. Bye for now.
[AGENT][POSITIVE] You as well thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah.