AccountId: 011433970860
ContactId: c1ccba5c-d8ba-42fb-8350-0ee085b791ea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 573940 ms
Total Talk Time (AGENT): 181708 ms
Total Talk Time (CUSTOMER): 137640 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/c1ccba5c-d8ba-42fb-8350-0ee085b791ea_20250107T14:12_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good Morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is calling from providers also checking on the claim status.
[AGENT][NEUTRAL] OK, sure, I can assist you with the claim status, Ms. [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you and may I have the policy number of the patient?
[CUSTOMER][NEUTRAL] It is 1241932 M as in Mike, L as in Lima, and number 8.
[AGENT][NEUTRAL] Thank you. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] At least
[CUSTOMER][NEUTRAL] [PII] for $59 even.
[AGENT][NEUTRAL] OK, let me see if I can find this claim.
[AGENT][NEUTRAL] And for future, you can check claim status online through our website at [PII] and that's just optional. And you said it was [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] And you said the total charge is $459?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, the procedure code 99214.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Alright, so it looks like we received the claim [PII].
[AGENT][NEGATIVE] 24 and we processed [PII] and the claim was denied, office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the claim number?
[AGENT][NEUTRAL] Yeah, sure. The claim number is 353-8598.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, you said that the claim was in office was was not covered by the policy, right?
[AGENT][NEUTRAL] Correct office visits are not covered under the member's plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, is there anything else I'm gonna help you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] Uh, one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, may I know the, what plan is having for the patient?
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, fine. Could you please let me know your name?
[AGENT][NEUTRAL] Sure. My name is [PII]. That's initial [PII].
[CUSTOMER][NEUTRAL] OK. I'll call your friends. I have 2 more clients. Uh, so, could you please assist with me?
[AGENT][NEUTRAL] Mm OK. Is it different members?
[CUSTOMER][NEUTRAL] Yes, different numbers. Uh, can you please let me know the call difference for this claim?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name and the same.
[CUSTOMER][NEUTRAL] OK, fine.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] We'll go for one more claim.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] Uh, one moment. I'm pulling up the claim. Just one moment, bear with me.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It is 015485.
[CUSTOMER][NEUTRAL] 07 M as in Mike, L as in Lima, and number 7.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It is [PII], [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] 2024.
[CUSTOMER][NEUTRAL] And the bill amount is $599 even.
[AGENT][NEUTRAL] How much again?
[CUSTOMER][NEUTRAL] 599
[AGENT][NEUTRAL] 599. OK, thank you. Let me see if I can find this one.
[AGENT][NEUTRAL] It was [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like we received the claim [PII] and we processed the claim on [PII].
[AGENT][NEUTRAL] make sure that's the same one, yeah, it is OK.
[AGENT][NEUTRAL] And it looks like the claim was denied stating that office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Same one, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. This is also, um, patient is having for secondary supplemental plan, right? Everything it was the same?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Could you please uh tell me the claim number?
[AGENT][NEUTRAL] Oh sure, the claim number on this one is 353-9484.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I will go for last name for the same number, this one.
[AGENT][NEUTRAL] Is this the same number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what's the date of service?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] How much is the total charge?
[CUSTOMER][NEUTRAL] $459.07.
[AGENT][NEUTRAL] Um, can you repeat the amount again?
[CUSTOMER][NEUTRAL] $459 even.
[AGENT][NEUTRAL] 4:59, OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] One moment, let me see if I find this one.
[AGENT][NEUTRAL] OK, looks like we received the claim [PII], processed [PII]. It's gonna be the same in our recent office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK and.
[CUSTOMER][NEUTRAL] Uh, when the claim was denied, it is [PII], right?
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] When when the claim was denied.
[AGENT][NEUTRAL] [PII], I, I'm sorry, [PII].
[CUSTOMER][NEUTRAL] OK, fine.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Could you please let me know the uh claim number?
[AGENT][NEUTRAL] Sure, the claim number is 353-9481.
[CUSTOMER][POSITIVE] OK, thank you so much for this information. So have a nice day.
[AGENT][POSITIVE] You as well and thank you for calling APL bye bye speaking.