AccountId: 011433970860
ContactId: c443e481-0b8a-4fa0-a766-cbc40336c035
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 248160 ms
Total Talk Time (AGENT): 104801 ms
Total Talk Time (CUSTOMER): 64327 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=2.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/c443e481-0b8a-4fa0-a766-cbc40336c035_20250502T14:54_UTC.wav
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[CUSTOMER][NEUTRAL] So.
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi [PII]. Good morning. My name is [PII] and last name initial for [PII]. I'm calling from provider's office regarding claim status.
[AGENT][NEUTRAL] OK, [PII], you're needing to check claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] Sure. [PII]. It is a direct line.
[AGENT][NEUTRAL] Thank you and how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] Only one client.
[AGENT][NEUTRAL] OK, and what is that member's policy number, please?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] What is the
[CUSTOMER][NEUTRAL] 0255
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah. It's 02556490.
[AGENT][NEUTRAL] OK, thank you one moment while I get the member's information pulled up, [PII].
[AGENT][NEUTRAL] And any information [PII] that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is [PII]. Uh and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Yes, sure.
[CUSTOMER][NEUTRAL] Uh, the date of service is [PII], and the total charge is $542 even.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and do you already have the claim number or you're needing the claim number as well, [PII]?
[CUSTOMER][NEUTRAL] Can you please provide the general claim status of this claim?
[AGENT][NEUTRAL] The claim was received on [PII], processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 35793997.
[AGENT][NEUTRAL] And the reason for the denial on this claim is that office visits are not covered by the above number policy.
[AGENT][NEUTRAL] The members supplemental plan does not cover office visits.
[CUSTOMER][POSITIVE] OK. Thank you so much. And
[AGENT][NEUTRAL] And if you're welcome and [PII], if you need a copy of that EOB with that remark, you can print it. If you go to our website for our portal and the website for that is secured. You already have that? OK, great.
[CUSTOMER][POSITIVE] Yeah, I already got it.
[CUSTOMER][POSITIVE] Yeah, yeah, I got it.
[AGENT][NEUTRAL] OK. Well, can I help you with anything else?
[CUSTOMER][POSITIVE] Thank you so much. And can you please provide the call reference number?
[AGENT][NEUTRAL] Yes, my name along with today's date.
[AGENT][NEUTRAL] And if you need the first initials.
[CUSTOMER][POSITIVE] Yeah. Thank you and thank you for giving me this information.
[AGENT][NEUTRAL] Oh, you're welcome. Do you need the first initial, [PII], to my last name?
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][POSITIVE] Yeah, thank you and thank you for giving this information. Have a nice day and happy weekend.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, yes, sir. And happy weekend to you as well, [PII]. Thank you again for calling APL.
[CUSTOMER][NEUTRAL] Yeah, bye bye.
[AGENT][NEUTRAL] Bye-bye.