AccountId: 011433970860
ContactId: c5062917-7969-45be-96b1-104c5b4c0adc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 235699 ms
Total Talk Time (AGENT): 91362 ms
Total Talk Time (CUSTOMER): 118184 ms
Interruptions: 4
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/c5062917-7969-45be-96b1-104c5b4c0adc_20250131T20:59_UTC.wav
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[AGENT][NEUTRAL] Call this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] On the
[CUSTOMER][NEUTRAL] Yeah, hello [PII]. I'm [PII]. Actually, I'm calling from provider's office regarding our claims.
[CUSTOMER][NEUTRAL] But.
[AGENT][POSITIVE] Sure, I can assist you with that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Can I have your callback number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] with an extension of.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Along with that be gonna help me.
[AGENT][NEUTRAL] And what is the policy number of the member that you're inquiring claim status for?
[CUSTOMER][NEUTRAL] September. Sure. The policy number is 02455014 M as in Mike L as in Lima H.
[CUSTOMER][NEUTRAL] Yes, yeah. Sure, my first name is going to be [PII]. It's [PII], [PII], and the last name is [PII] and the date of birth is.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And what is the data service that you're inquiring about today, [PII]?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII], uh, with the bill amount of $542 even.
[CUSTOMER][NEUTRAL] Member's date of birth is [PII].
[AGENT][NEUTRAL] And what was the member's date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The services provided are not covered under the policy. The claim was received [PII]. It was processed [PII]. Office visits for the policy is not covered under this member's policy.
[CUSTOMER][NEUTRAL] call reference number please.
[CUSTOMER][NEUTRAL] And by.
[CUSTOMER][NEGATIVE] OK, stating that, uh, uh, received on [PII] and pro and denied on.
[AGENT][NEUTRAL] The [PII].
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] The [PII].
[CUSTOMER][NEUTRAL] OK, when did you receive the claim.
[AGENT][NEUTRAL] OK, so as stated earlier, the claim was received [PII]. The claim was processed [PII]. There was no payment made on this claim because office visits for the policy are not covered under the policy. Would you like the claim number?
[CUSTOMER][NEUTRAL] Sure. OK. Could you please help me now what does the member plan has?
[AGENT][NEUTRAL] It does not cover office visit.
[CUSTOMER][NEUTRAL] Is a supplementary care members plan name. Could you please help me with the numbers?
[AGENT][NEUTRAL] This policy is terminated. This is a gap insurance, a meddling gap insurance that assists with deductible, co-pay, and co-insurance to the primary for services that's covered under the policy and office visits, unfortunately is not a covered service.
[CUSTOMER][NEUTRAL] Could you please help me the claim number?
[AGENT][NEUTRAL] 347-2073. That's 3472073.
[CUSTOMER][POSITIVE] Mhm. OK, thank you.
[CUSTOMER][NEUTRAL] Could you please help me the call reference?
[AGENT][POSITIVE] Is there anything else that I can assist you with? We don't provide reference numbers, however, you can use my name in today's date as a reference. Thank you for calling APLA have a great day.
[CUSTOMER][NEUTRAL] OK, can you spell your name? Yeah, hello. Can you spell your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And you said the last time.
[AGENT][NEUTRAL] [PII].