AccountId: 011433970860
ContactId: c5a522fa-cdf3-4f92-9f4d-ca029655336c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 212580 ms
Total Talk Time (AGENT): 77712 ms
Total Talk Time (CUSTOMER): 129756 ms
Interruptions: 8
Overall Sentiment: AGENT=0.7, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/c5a522fa-cdf3-4f92-9f4d-ca029655336c_20250123T18:23_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh hi, [PII]. My name is [PII]. I'm calling from provider office and checking the claim status.
[AGENT][NEUTRAL] OK, yeah, I can check on a claim for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. Uh, you would call me at [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][POSITIVE] Ok thank you and the policy number.
[CUSTOMER][NEUTRAL] Yes, I do have that.
[CUSTOMER][NEUTRAL] Uh, the policy number is
[CUSTOMER][NEUTRAL] 023698
[CUSTOMER][NEUTRAL] 26 M. like Mary L. like Larry number 8.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] And this is for [PII], [PII].
[AGENT][NEUTRAL] Thank you for verifying that [PII]. Uh, what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Thank you for verify the date of [PII].
[AGENT][NEUTRAL] I'm sorry, that was [PII]?
[CUSTOMER][POSITIVE] That was [PII]. Yes, correct.
[AGENT][NEUTRAL] OK, and the bill out please?
[CUSTOMER][NEUTRAL] $521 even.
[AGENT][NEUTRAL] 521. OK, thank you one moment.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][NEUTRAL] OK, I'm not showing that we received a claim for that data service give me just a moment.
[CUSTOMER][NEUTRAL] Received a claim for that data service. Give me just a moment.
[AGENT][NEUTRAL] As this policy was not active during that time, let me see if she had one that was.
[CUSTOMER][NEUTRAL] This policy was active during that time. Let me see if she was.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] OK, so I did find this claim, [PII] it was under a different policy that was active during that time.
[CUSTOMER][NEUTRAL] OK, so it's not this kind.
[CUSTOMER][NEUTRAL] Policy that was.
[AGENT][NEUTRAL] What was the name of the provider's office?
[CUSTOMER][NEUTRAL] Uh, this was for uh this is Florida physician.
[AGENT][NEUTRAL] OK, yes, perfect. All right, so we were unable to pay a benefit as office visits are not covered under this policy.
[CUSTOMER][POSITIVE] Yes, perfect. OK so.
[CUSTOMER][NEUTRAL] Benefit has often visits up for this policy. OK, perfect. So this was denied as the office visit is not covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] M is liable on that one.
[AGENT][NEUTRAL] We don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK, but as for the member policy with you, uh, he should not be billing you guys for the office visit, right?
[AGENT][NEGATIVE] Right, we wouldn't be able to pay a benefit as their policy doesn't cover that.
[CUSTOMER][NEUTRAL] Right, OK, perfect. Do you happen to have a call reference number and a claim number claim number just to confirm on that one I do have 1 3541667.
[AGENT][NEUTRAL] Of course, the claim number
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes sir, that's correct.
[CUSTOMER][NEUTRAL] Yes, that's correct. The car reference number please.
[AGENT][NEUTRAL] Caller reference number would just be my first name, last initial, and today's date and so my name is spelled [PII] Was there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] would be my first name, last name spell it. Oh no, thank you so very much. It was really nice talking to you. Have a great rest of your day.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Of course you too thanks for calling us [PII]. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] This day.