AccountId: 011433970860
ContactId: d22e3fed-2cb5-43fe-bf91-ddeae79f13ff
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 397600 ms
Total Talk Time (AGENT): 125382 ms
Total Talk Time (CUSTOMER): 138425 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/d22e3fed-2cb5-43fe-bf91-ddeae79f13ff_20250620T17:49_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh yeah, hi, this is [PII] calling from provider's office regarding claim sales.
[AGENT][NEUTRAL] Sure, I can assist you with that. Could you provide me with the spelling of your name and the callback number?
[CUSTOMER][NEUTRAL] Uh, that is [PII]. Callback number is [PII].
[AGENT][NEUTRAL] Thank you. And what is the policy number of the member that you're calling to verify claim status for?
[CUSTOMER][NEUTRAL] Uh, that is 01603016.
[AGENT][NEUTRAL] [PII], could you verify that patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] That's the last name, [PII], date of birth?
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm. Uh, and before we proceed, I would like to
[AGENT][NEUTRAL] And what is the date of service that you're calling to check the status of the claim for?
[CUSTOMER][NEUTRAL] Uh, yeah, but before we proceed, I would like to inform you this call is being recorded for training and quality purposes. So I hope you're OK with that.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, date of service is [PII].
[CUSTOMER][NEUTRAL] Billed amount $583 even.
[AGENT][NEUTRAL] Can you provide me with a procedure code?
[CUSTOMER][NEUTRAL] 87491.
[AGENT][NEUTRAL] 87491.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] 425.
[AGENT][NEGATIVE] The claim was received [PII]. It was processed [PII]. There was no payment because the policy was terminated. The member's policy was active from [PII] and it was terminated [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK. So member is not active with another policy?
[AGENT][NEUTRAL] No, the member has no active policy here at American Public Luxury.
[CUSTOMER][NEUTRAL] OK. OK. Can I get the claim number?
[AGENT][NEUTRAL] Yes, the claim number?
[AGENT][NEUTRAL] It's 359-425-4. That's 359-4254.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and I do have another, just uh one more claim, so call the number for this one.
[AGENT][NEUTRAL] We don't provide reference numbers. You can use my name in today's date as a reference.
[CUSTOMER][NEUTRAL] OK. OK, then, just a moment to put me another claim details.
[CUSTOMER][NEUTRAL] Uh, next one is 019.
[CUSTOMER][NEUTRAL] 7989.
[AGENT][NEUTRAL] That's the policy number or that's the date of service? Is this a different policy?
[CUSTOMER][NEUTRAL] Oh, that's all
[CUSTOMER][NEUTRAL] Uh, yeah, different number, different policy number.
[AGENT][NEUTRAL] OK, I'm ready for the policy number.
[CUSTOMER][NEUTRAL] 019.
[CUSTOMER][NEUTRAL] 7989.
[AGENT][NEUTRAL] OK, is there any more numbers to the policy?
[CUSTOMER][NEUTRAL] Uh, let me check. I don't have any other numbers with me. Just a moment.
[AGENT][NEUTRAL] Do you have a copy of the card to verify the policy number is accurate?
[CUSTOMER][NEUTRAL] Oh yeah, just a moment. Let me confirm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, no, actually, I don't have. Can you check with name and date of birth?
[AGENT][NEUTRAL] Do you have the member's social, [PII]?
[CUSTOMER][NEUTRAL] Oh, yeah, that is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is this member's name?
[CUSTOMER][NEUTRAL] Uh last name is first name is [PII]
[AGENT][NEUTRAL] And what is her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the data service that you're calling about?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So let me give you the correct policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 19798997. It's 19798997.
[AGENT][NEUTRAL] The claim, this policy has been active since [PII] and it's currently active.
[CUSTOMER][NEUTRAL] But.
[AGENT][NEUTRAL] And what is your procedure code for [PII]?
[CUSTOMER][NEUTRAL] 87624.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] This claim was received [PII]. It was processed [PII]. There was no payment made on the claim, and the reason why there was no payment made on the claim is because the policy does not cover procedures done in the office. Treatment received in the office is not covered for the policy.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Treatment received in just a moment.
[CUSTOMER][NEUTRAL] OK, can I get the claim number?
[AGENT][NEUTRAL] Claim number is 3600106.
[CUSTOMER][NEUTRAL] OK. Uh, may I also know the policy name or plan name of the member?
[AGENT][NEUTRAL] This is a midlink policy.
[CUSTOMER][POSITIVE] All right. OK then, thank you so much. Have a good day.
[AGENT][POSITIVE] You're welcome. Thanks for calling APA. You have a great one as well. Goodbye.
[CUSTOMER][NEUTRAL] Bye bye.