AccountId: 011433970860
ContactId: c9fba363-d1e9-4079-ba00-bbc4705cbb5f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 236100 ms
Total Talk Time (AGENT): 94008 ms
Total Talk Time (CUSTOMER): 48193 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/c9fba363-d1e9-4079-ba00-bbc4705cbb5f_20250513T13:41_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Um, yes, I was calling just to um to claim status for a patient.
[AGENT][NEUTRAL] OK, I can verify claim status for you and your name is?
[CUSTOMER][NEUTRAL] It is [PII]
[AGENT][NEUTRAL] Thank you, ma'am. And what is that policy number?
[CUSTOMER][NEUTRAL] Yes, give me a minute um.
[CUSTOMER][NEUTRAL] Policy number is 02612541.
[AGENT][NEUTRAL] Thank you, ma'am. Give me a moment and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, it is [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you. And patient's name, date of birth?
[CUSTOMER][NEUTRAL] It is [PII], [PII].
[AGENT][POSITIVE] OK, thank you so much. And you say you're calling to verify claim status, correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, and what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] It is 4 1425.
[CUSTOMER][NEUTRAL] And then it was 179 with 85 cents.
[AGENT][NEUTRAL] And you said [PII] of this year?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you, ma'am. Give me one moment please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And while looking up claim information just to let you know we do have an online service center where providers can check claim status as well as print out the EOB. That site is at [PII].
[AGENT][NEUTRAL] And you're calling from?
[CUSTOMER][NEUTRAL] It is [PII] and your Medical Service.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, I'm showing the claim process as the claim submission received has been noted as an accident or injury. Uh, the outpatient sickness writer allows payment for sickness only, therefore benefits are not uh payable.
[CUSTOMER][NEUTRAL] OK, what is the reason for the one more time? I'm sorry.
[AGENT][NEUTRAL] The diagnosis uh shows to be an accident or injury, and under the patient's policy, they have an outpatient sickness benefit rider that allows for sickness only, so it's not covered.
[CUSTOMER][NEUTRAL] OK, and then do you have that claim number?
[AGENT][NEUTRAL] Yes, ma'am. It's 359-865-4.
[CUSTOMER][NEUTRAL] 359-865-4
[AGENT][NEUTRAL] Uh, yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then your name?
[AGENT][NEUTRAL] Uh, my name is [PII].
[CUSTOMER][NEUTRAL] And the reference number please.
[AGENT][NEUTRAL] Uh, if you like, you may use my name and today's date.
[CUSTOMER][POSITIVE] OK, that is all I needed and thank you for your help.
[AGENT][POSITIVE] Alright, you are welcome. Thank you for calling APO Ms. [PII]. Have a great day.
[AGENT][NEUTRAL] Bye.