AccountId: 011433970860
ContactId: d5f27423-9458-4604-84d1-3fbff5e149f1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 735109 ms
Total Talk Time (AGENT): 302549 ms
Total Talk Time (CUSTOMER): 103161 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/d5f27423-9458-4604-84d1-3fbff5e149f1_20250213T14:51_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good excuse me. Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I wish it was afternoon already.
[AGENT][NEUTRAL] Me too.
[AGENT][NEUTRAL] Me too. I sure have my mind on the afternoon apparently, didn't I?
[AGENT][POSITIVE] Well, at least we had a laugh this morning.
[CUSTOMER][POSITIVE] Good morning to you. I
[CUSTOMER][POSITIVE] I'm good. How are you?
[AGENT][POSITIVE] I'm doing fine, thank you. How can I help you?
[CUSTOMER][POSITIVE] I'm, I'm great to hear that. I do have 3 patients to check on medical claim status, please.
[AGENT][NEUTRAL] OK, you have 3 patients. Do they each have 1 data service that you're needing to check status for? Yes, ma'am, I can help you with that. And who am I speaking with?
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII] is my name.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you. [PII]?
[CUSTOMER][NEUTRAL] With the the [PII].
[AGENT][NEUTRAL] OK. [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, [PII], thank you and what is a good call back number for you please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and so [PII], you will use my name along with today's date as each of your call reference numbers.
[AGENT][NEUTRAL] Also, if we do have the claim any information first off on any of them that I provide for you will be a verification of benefits and not a guarantee of payment. And lastly, if we do have the claims on file, [PII] and you need a copy of any of the explanation of benefits, you may print them once you have the claim number by going to our portal, which is the website for that is secured.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're very welcome. And so what is your first patient's policy number, please?
[CUSTOMER][NEUTRAL] I have
[CUSTOMER][NEUTRAL] 01
[CUSTOMER][NEUTRAL] 947
[CUSTOMER][NEUTRAL] 059.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her place, [PII]?
[CUSTOMER][NEUTRAL] Yeah, sure. [PII].
[CUSTOMER][NEUTRAL] For $296.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you did say it is [PII]. Is that correct?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK, so we do not have a claim on file under this policy number for her.
[AGENT][NEUTRAL] Actually, this policy would not have been active for that data service. This policy termed 11-12022. Let me see.
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] She had another policy that was active.
[AGENT][NEUTRAL] From [PII].
[AGENT][NEUTRAL] That policy number is 226.
[AGENT][NEUTRAL] 7917.
[AGENT][NEUTRAL] And give me just a moment to see if the um claim was received and processed under the correct number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK just a moment.
[AGENT][NEUTRAL] So and it was so the
[AGENT][NEUTRAL] Oh excuse me, the claim was received on [PII] and it was processed and denied on [PII].
[AGENT][NEUTRAL] The claim number is 3552386.
[AGENT][NEUTRAL] And give me just a moment to pull up.
[AGENT][NEUTRAL] This full policy information.
[AGENT][NEUTRAL] Uh, the reason for the denial on this claim, out, uh, carry.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is that office visits are not covered by the above numbered policy. The supplemental policy does not cover office visits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Awesome thank you
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And do you need any other information on this policy?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][NEUTRAL] OK, one moment
[AGENT][NEUTRAL] And again, I did give you that this policy was active from [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me a second really quick really quick.
[AGENT][NEUTRAL] OK, and what is your next patient policy number [PII]?
[CUSTOMER][NEUTRAL] Policy number is 02419343.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth is
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. The date of service and total bill amount please.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And this bill amount is $296.
[AGENT][NEUTRAL] OK, so this policy was also not active for your data service. It turned 10-12024. Let me see if there's another policy.
[AGENT][NEUTRAL] For him, that's
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so the current active policy is 02556447.
[AGENT][NEUTRAL] With an effective date of [PII].
[AGENT][NEUTRAL] And let me check to see if it was processed in with you.
[AGENT][NEUTRAL] OK, so this claim was also received on this policy. It was received on [PII].
[AGENT][NEUTRAL] And it was denied on [PII].
[AGENT][NEUTRAL] And the claim number is 3561211.
[AGENT][NEGATIVE] And it was also denied for the same reason, office visits are not covered.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Alright, so let me make my note on this one and then we'll do your next one.
[AGENT][NEUTRAL] OK, and your next patient's policy number please, [PII]?
[CUSTOMER][NEUTRAL] Sure. That is 00971045.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][POSITIVE] Oh, excuse me, [PII], I'm so sorry.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And your patient's name and date of birth on this policy?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the date of service and total bill amount?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] $296.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so we've received this claim more than once. The last one was denied as a duplicate of previously submitted expenses. So do you want the original claim received?
[CUSTOMER][NEUTRAL] Mostly, yeah.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, it was received on [PII], processed and denied on [PII]. The claim number is 3537085.
[AGENT][NEGATIVE] And it was also denied for the same reason, office visits are not covered.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You are certainly very welcome.
[AGENT][NEUTRAL] And is there any
[CUSTOMER][POSITIVE] What was your name again? I'm so sorry.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII], thank you so much. You have a great day. Thank you.
[AGENT][POSITIVE] Yes, ma'am. Well, I hope you have a great day too, and if that's all I can help you with, and thank you again very much for calling APL today, [PII].
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Ah, bye bye.
[CUSTOMER][NEUTRAL] OK.