AccountId: 011433970860
ContactId: cf4bd80c-8d76-4b2e-8052-4cb21078f312
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 297109 ms
Total Talk Time (AGENT): 134031 ms
Total Talk Time (CUSTOMER): 79134 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/cf4bd80c-8d76-4b2e-8052-4cb21078f312_20250306T19:20_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office and looking on a claim status. Can you help me?
[AGENT][POSITIVE] Of course, I'll be more than happy to help you with the claim status, [PII]. May I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, the policy number is 0214836.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] Um, so 0214836, there's a number missing.
[CUSTOMER][NEUTRAL] Yeah. After 8364 ML 8.
[AGENT][NEUTRAL] 4, OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the member's name is.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], date of birth, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] It's [PII] for $300 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so the 2148364 policy number termed on [PII]?
[AGENT][NEUTRAL] There is an active policy that's been effective since [PII], and that's 232.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 9703.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I'm going to look on the.
[CUSTOMER][NEUTRAL] 23297003
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm going to look on this policy to see if there's a um claim for you. Hold on one moment. And this is for [PII], right?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so I'm showing the policy or the claim, I'm sorry, was received on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3569088.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] Office visit is not covered by meddling policy.
[AGENT][POSITIVE] Correct, my patient's policy, yes.
[CUSTOMER][NEUTRAL] And so it's a patient responsibility?
[AGENT][NEUTRAL] So we don't determine patient responsibility because we're not the major medical insurance company, um, so it'll be whatever your policy is on outstanding or remaining balances.
[CUSTOMER][NEUTRAL] OK. And the claim number is 3569088.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And can you fax me the EOB?
[AGENT][NEUTRAL] Yes, and what's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I ask attention [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Alrighty, well, I'll go ahead and send the explanation benefits over to you now. Was there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] When we will receive the UV?
[AGENT][POSITIVE] Um, we usually say um give it at least an hour since we're um faxing it over to you. If you haven't received it by the end of day today, you can definitely give us a call and we'll be more than happy to uh resend it for you.
[CUSTOMER][NEUTRAL] OK. Can you spell your name for me?
[AGENT][NEUTRAL] Yes, my name is [PII] The [PII] name is [PII].
[CUSTOMER][NEUTRAL] Thank you. And the call reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date.
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so much for the information you provided me on this call.
[AGENT][POSITIVE] You're very welcome. Well, thanks for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] You too as well. Thank you. Bye.
[AGENT][POSITIVE] Thank you. You're welcome. Bye bye.