AccountId: 011433970860
ContactId: bafa9d3b-1e32-4ffd-ba59-e8cf81708895
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 327859 ms
Total Talk Time (AGENT): 62676 ms
Total Talk Time (CUSTOMER): 149144 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/bafa9d3b-1e32-4ffd-ba59-e8cf81708895_20250604T14:52_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Skin and Cancer Associates. How are you doing today?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][POSITIVE] I'm also doing good, thank you for asking. And I'm calling to check the claim status.
[AGENT][POSITIVE] I'd be happy to assist with claim status today so low if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Yes, before I proceed with that, please be informed that this call has been recorded for quality and training purpose. Would you like us to continue the recording?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Yes, thank you. And my good callback number is [PII] and it is a direct line.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Uh, yes, before I proceed with the policy number, may I confirm your name? It is [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, thank you, [PII]. And may I also know your last name initial, please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh thank you, [PII]. Thank you for that. And the member's policy number is 01678145.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes patient first name is?
[CUSTOMER][NEUTRAL] [PII], and the last name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] And what is the data service?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And the tax ID.
[CUSTOMER][NEUTRAL] Tax ID?
[CUSTOMER][NEUTRAL] Yes, and the tax ID is
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you for that information. I'm showing that the claim denied because office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] Uh, may I, uh, may I know when was this claim received?
[AGENT][NEUTRAL] Uh, claim was received on.
[AGENT][NEUTRAL] I'm sorry, what's that data service please again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Claim was received on [PII]. Claim denied on [PII].
[CUSTOMER][NEUTRAL] Received on [PII] and denied on [PII].
[CUSTOMER][NEUTRAL] Uh, OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And office visits are not covered under the patient's plan?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And may I know the reason why the office visits are not covered for this patient?
[AGENT][NEUTRAL] That's not a part of what's covered under their policy. It's written in the policy language.
[CUSTOMER][NEUTRAL] OK. So, as we don't have any response on our records, can you please send us the UV through our fax number?
[AGENT][NEUTRAL] What's the fax number?
[CUSTOMER][NEUTRAL] Yes, and our fax number is [PII].
[AGENT][NEUTRAL] And to whose attention?
[CUSTOMER][NEUTRAL] Uh it is my name, [PII], and my last name initial is [PII].
[AGENT][NEUTRAL] Alright, you should receive that fax in the next 15 minutes. Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Yes, I do also have another claims to check the status. Can you please help me with that?
[AGENT][NEUTRAL] Is it the same patient or a different patient?
[CUSTOMER][NEUTRAL] Different patient.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Yes. Yes, the next, next patient's policy number is
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] Please wait for a moment. My system is getting updated.
[CUSTOMER][NEUTRAL] Yes. The next patient's policy number is 01369754 M as in Mike, L as in Lima and number 8.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes, member's first name is
[CUSTOMER][NEUTRAL] [PII], last name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] And the date of service is [PII].
[AGENT][NEUTRAL] OK, I'm showing claim denied because office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] Of visits are not covered under the policy.
[CUSTOMER][NEUTRAL] OK, please, uh.
[CUSTOMER][NEUTRAL] OK. Uh,