AccountId: 011433970860
ContactId: d495cf6f-1c8f-437b-8cd9-bb1895619fc1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 389929 ms
Total Talk Time (AGENT): 130193 ms
Total Talk Time (CUSTOMER): 78071 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/d495cf6f-1c8f-437b-8cd9-bb1895619fc1_20250103T21:34_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, hi, this is [PII] from Provida So. I just wanted to check on a client status for a patient.
[AGENT][NEUTRAL] OK, sure, I can see your claim status. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] That is [PII].
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 01648352 M as in Mike 17.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] with the date of birth of [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the date of service and the amount of the claims?
[CUSTOMER][NEUTRAL] That is uh [PII].
[AGENT][NEUTRAL] And how much is the total charge for the claim?
[CUSTOMER][NEUTRAL] $304 even.
[AGENT][NEUTRAL] I'm sorry, I didn't get that. Can you repeat?
[CUSTOMER][NEUTRAL] 304.
[AGENT][NEUTRAL] 304. OK, and that was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Let me check on that for you. And for the future, you can check my status online through our website at [PII], and that's just optional.
[AGENT][NEUTRAL] And bear with me.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] I don't have a claim for [PII].
[AGENT][NEUTRAL] Um, let me check the effective day and make sure it's the right one.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Old policy let me see if there's another one.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] this one.
[AGENT][NEUTRAL] OK. I think I found it then. You said it was how much again?
[CUSTOMER][NEUTRAL] There's $304 even?
[AGENT][NEUTRAL] What is the procedure called?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] What is the procedure code?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh, that will be one minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] OK, the procedure codes will be one month. My system is too slow.
[CUSTOMER][NEUTRAL] One minute.
[CUSTOMER][NEUTRAL] OK, the postal code will be [PII].
[AGENT][NEUTRAL] Is that the only code?
[CUSTOMER][NEUTRAL] No, I have other code like [PII] and [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't have a claim for 3 or 4 then.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, do you have the client for over the post code of [PII]?
[AGENT][NEUTRAL] How much is just um that code, you know.
[CUSTOMER][NEUTRAL] $189.
[AGENT][NEUTRAL] Yes, I have that one. yes, um, the one for 189 for procedure code 99214 date of service, [PII] was processed on [PII].
[AGENT][NEGATIVE] And it was denied stating office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK, can I have the claim number first?
[AGENT][NEUTRAL] Sure, the claim number is 3441383.
[CUSTOMER][NEUTRAL] OK, what, uh, denied date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, denial of reason.
[AGENT][NEUTRAL] Office visits are not covered under the member's plan.
[CUSTOMER][NEUTRAL] OK, can I have your name spelled?
[AGENT][NEUTRAL] My name?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. My name is [PII], that's [PII]. Last [PII] is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can I have the call reference?
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's name if you will.
[AGENT][NEUTRAL] Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] OK, that's all for today. Thank you.
[CUSTOMER][NEUTRAL] Oh that's
[AGENT][POSITIVE] You're welcome. All right, well, thank you for calling EPL. Have a good day. Mm bye-bye, Mr. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] You too bye take care.
[AGENT][POSITIVE] Thank you. You too. Bye-bye.