AccountId: 011433970860
ContactId: c018eaf7-8f3c-44a7-98a2-5f2c756dbc13
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 248860 ms
Total Talk Time (AGENT): 106488 ms
Total Talk Time (CUSTOMER): 83898 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/c018eaf7-8f3c-44a7-98a2-5f2c756dbc13_20250130T16:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes, hi, this is [PII] calling from Provani's office checking on claims.
[AGENT][NEUTRAL] Sure, [PII], I can help you with the claim status. Can I please have a callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes, my callback number is [PII] with an [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And can you tell me the policy number or member ID please?
[CUSTOMER][NEUTRAL] Yes. The policy number is 02543091.
[AGENT][NEUTRAL] Thank you [PII] and can you tell me the name of the facility or provider's office you're calling from today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, the provider's office is Graves Gilbert Clinic.
[AGENT][NEUTRAL] OK
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And just one moment please.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And may I please have you verify patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, member's first name is [PII] and the last name is [PII].
[CUSTOMER][NEUTRAL] Date of birth, [PII].
[AGENT][NEUTRAL] OK [PII], thank you for verifying that. Can you please um tell me the date of service and the amount on your claim?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah, the data service is [PII]. The amount $280 even.
[AGENT][NEUTRAL] $280 123 [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Just give me one moment please.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, just give me one moment to pull up the claim image.
[AGENT][NEUTRAL] I do have the claim on file.
[CUSTOMER][POSITIVE] Yes, please take your time.
[AGENT][NEUTRAL] OK, $280 date of service is [PII]. I show the claim received date is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, the claim was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim number 35.
[AGENT][NEUTRAL] 43
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] 543.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim was denied on [PII]. It was denied due to uh the service, the service isn't covered under the member's plan. um they have um they have a limited hospital, uh, limited medical hospital indemnity, and the claim, uh, the claim line that was billed is a, uh, wellness preventative, uh, procedure and that is not covered, so they have no wellness coverage under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] And I really do apologize. Can I have a good name once again?
[AGENT][POSITIVE] Certainly, my first name [PII] [PII].
[AGENT][NEUTRAL] And you'd use my name and today's date is your call reference number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And yes, and yes, I do wanna inform you, [PII], and apart from this, I don't have any other further claims for today. So thank you for your time and thank you for assisting me and hope you have a great day, stay safe, take care.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] You too, thank you for calling APL have a great day bye bye.
[CUSTOMER][NEUTRAL] Bye for now.
[CUSTOMER][NEUTRAL] Bye-bye.