AccountId: 011433970860
ContactId: cb58bf2f-4e82-4b03-959c-50cdbf4cd9e7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 225429 ms
Total Talk Time (AGENT): 105834 ms
Total Talk Time (CUSTOMER): 40610 ms
Interruptions: 0
Overall Sentiment: AGENT=2.2, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/cb58bf2f-4e82-4b03-959c-50cdbf4cd9e7_20250620T14:40_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] with um Commonwealth Primary Care. I'd like to speak to someone um.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, to, uh, I'm sorry, I'd like to be someone regarding a claim.
[AGENT][NEUTRAL] OK, [PII], so you're needing to check claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] 02131571
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII] date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the data service and total bill amount for her place?
[CUSTOMER][NEUTRAL] [PII] $257.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I do show that this claim was received, [PII]. The claim was received on [PII].
[AGENT][NEGATIVE] And it was processed and denied on [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] The claim number is going to be 3583568.
[CUSTOMER][NEUTRAL] OK, and
[AGENT][NEUTRAL] And the reason for the denial on here is that office visits are not covered by the above numbered policy. This member supplemental policy does not cover office visits.
[AGENT][NEGATIVE] And the other two codes were reviewed and they were denied.
[AGENT][NEUTRAL] As insured's primary insurance provided full benefits, there are no benefits payable.
[AGENT][NEUTRAL] And if you need a copy of that explanation of benefits, which one was mailed, but if you need a copy of it, you can print it from our portal or you should be able to now that you have the claim number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the website for that [PII] is secured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And what was your name again?
[AGENT][NEUTRAL] [PII] and my name and today's date will be used as your call reference number if you need one.
[CUSTOMER][POSITIVE] Alrighty thank you so much for your help I appreciate it.
[AGENT][POSITIVE] Oh, you're very welcome, [PII]. Can I help you with anything else?
[CUSTOMER][POSITIVE] That's gonna do it thank you so much.
[AGENT][POSITIVE] Well, you're welcome and thank you for calling APL. I hope you have a wonderful weekend.
[CUSTOMER][POSITIVE] You too. Thank you. Bye-bye.
[AGENT][POSITIVE] Thank, uh-huh. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.