AccountId: 011433970860
ContactId: ca9db111-9053-49c3-8fb3-4d781a213f5d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 368109 ms
Total Talk Time (AGENT): 104156 ms
Total Talk Time (CUSTOMER): 62483 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/ca9db111-9053-49c3-8fb3-4d781a213f5d_20250122T17:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APO. This is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Hi [PII], I was calling to get claim status please on medical claim.
[AGENT][NEUTRAL] I can assist you with claim status. May I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], can I please have a callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] May I have the policy number of the member?
[CUSTOMER][NEUTRAL] It is 0198944218.
[CUSTOMER][NEUTRAL] Or I
[CUSTOMER][NEUTRAL] That I.
[AGENT][NEUTRAL] Will you please
[AGENT][NEUTRAL] Verify the member's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] I would, thank you so much for verifying the information that you're calling for claim status. Could you please verify the date of service you're calling about today?
[CUSTOMER][NEUTRAL] Uh, the first day of service is [PII].
[AGENT][NEUTRAL] Charge amount please.
[CUSTOMER][NEUTRAL] Total amount of the claim was for $350.
[AGENT][NEUTRAL] That claim was received on [PII]. That claim is processed on [PII].
[AGENT][NEUTRAL] Um, let me see what it did.
[AGENT][NEUTRAL] All right.
[AGENT][NEGATIVE] It denied this one line with office visits are not covered under this member's policy.
[AGENT][NEUTRAL] The next one
[AGENT][NEGATIVE] Was also um the service is not covered when performed in a doctor's office or a clinic.
[AGENT][NEUTRAL] So both of those lines did not pay.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Patient policy. OK. And may I please have the claim number?
[AGENT][NEUTRAL] 3549533
[AGENT][NEUTRAL] Did you say you had another data service?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, 9-172024.
[AGENT][NEUTRAL] Charge amount please.
[CUSTOMER][NEUTRAL] It's for a total of
[CUSTOMER][NEUTRAL] $2,063.98.
[AGENT][NEUTRAL] That claim was received on [PII], it processed on [PII].
[AGENT][NEUTRAL] And all of those lines did deny as services are not covered in um when performed in a doctor's office or a clinic.
[CUSTOMER][NEUTRAL] So her policy only cover.
[AGENT][NEUTRAL] And that would be under claim.
[AGENT][NEUTRAL] Claim 3549536.
[CUSTOMER][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] So her policy only cover hospital claims?
[AGENT][NEUTRAL] One moment while let me pull up the policy. Let me see if I can assist you. If I can, I have to send you to the correct department.
[AGENT][NEUTRAL] So while I pull up the policy, this is a verification of the coverage and not a guarantee for payment.
[CUSTOMER][POSITIVE] Mm, that's right.
[AGENT][NEUTRAL] So looking under the policy, they do have outpatient benefits, but the outpatient benefits is for like um surgery in a hospital, um diagnostic testing, physical therapy, ambulance, hospital emergency room, but anything, um, there's nothing for a doctor's office.
[CUSTOMER][NEUTRAL] OK, that's fine, thank you. Can I get a reference number?
[AGENT][NEUTRAL] It will be my name in today's date.
[CUSTOMER][POSITIVE] OK, thank you very much have a good day.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you so much for calling APO. Have a great day, [PII]. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.