AccountId: 011433970860
ContactId: ca0c9ee6-b54a-4680-9db2-0c7a14fe307b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 197770 ms
Total Talk Time (AGENT): 96794 ms
Total Talk Time (CUSTOMER): 63872 ms
Interruptions: 0
Overall Sentiment: AGENT=2.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/ca0c9ee6-b54a-4680-9db2-0c7a14fe307b_20250425T15:10_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. [PII] speaking. How may I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII], and I'm calling uh for claim status.
[AGENT][NEUTRAL] And if you spell your first name for me, please.
[CUSTOMER][NEUTRAL] Yes, it is [PII]
[AGENT][POSITIVE] Thank you and your callback number please.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you. What is the policy number, please, [PII]?
[CUSTOMER][NEUTRAL] It is 02473100 ML 8.
[AGENT][NEUTRAL] OK, thank you. Let me just repeat that to you. I have that as 02473100 ML8.
[CUSTOMER][NEUTRAL] 8, yeah, number 8 at the end.
[AGENT][NEUTRAL] Thank you. And verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, it is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, I have that member pulled up and then you call for claim status. Give me one moment. I can help you with that. And also you can check claim status by visiting our secure portal at [PII]. Give me one second, please. Just hold on. Thank you, and give me that date of service and total charge amount please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 2
[CUSTOMER][NEUTRAL] Yes, it is [PII] for 340.
[AGENT][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Almost done. Thank you so much for your patience.
[CUSTOMER][NEUTRAL] That she has been taking weight period.
[AGENT][NEUTRAL] OK, thank you. Uh, it shows that the claim was excuse me, received on [PII] and processed and denied on [PII]. The charges were denied. Um, office visit procedure code 99244 denied as office visits are not covered by this policy and procedure code 93,000 denied as service not covered when performed inside the doctor's office or clinic.
[CUSTOMER][NEUTRAL] Um, where can I find that EOB because I haven't received that.
[AGENT][NEUTRAL] OK, that is available on our website at secured.
[AGENT][NEUTRAL] [PII] or I can actually fax this over to you. What is your fax number?
[CUSTOMER][NEUTRAL] Not
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you have a claim number? Because I'm here on the website.
[AGENT][NEUTRAL] I do. The claim number is 3538904.
[CUSTOMER][NEUTRAL] OK, let me see if I can find it here.
[AGENT][POSITIVE] OK, awesome, thank you for trying.
[CUSTOMER][NEUTRAL] Yeah, I have it here.
[AGENT][POSITIVE] OK, awesome awesome.
[CUSTOMER][NEUTRAL] Yes, I have it here.
[AGENT][POSITIVE] Thanks Ga I appreciate that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect thank you so much.
[AGENT][POSITIVE] You're welcome and thank you for calling APL you have a great weekend bye.
[CUSTOMER][POSITIVE] Thank you you too bye bye.