AccountId: 011433970860
ContactId: d7913a5a-837d-4d2b-852a-adc6f7c0e3ce
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 388470 ms
Total Talk Time (AGENT): 130513 ms
Total Talk Time (CUSTOMER): 127535 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/d7913a5a-837d-4d2b-852a-adc6f7c0e3ce_20250502T19:07_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office checking for claim status.
[AGENT][NEUTRAL] OK, and you say your name is [PII] or [PII]? I apologize.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Oh, [PII]. OK. And Miss [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Policy number is D4412.
[CUSTOMER][NEUTRAL] 031
[CUSTOMER][NEUTRAL] 90
[AGENT][NEUTRAL] Uh, it's not one of our policy numbers. You have the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Um, just a moment.
[CUSTOMER][NEUTRAL] OK. Patient's name is [PII], and the last name spelled as [PII], again, [PII].
[AGENT][NEUTRAL] OK, and [PII], how is she spelling it? Is it S [PII]?
[CUSTOMER][NEUTRAL] Um [PII] Yes, right.
[AGENT][NEUTRAL] OK, thank you. And Ms. [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Uh, callback number is [PII]. It's a direct line.
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] Mm OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I do not show that patient in our system. Do you have a copy of the card in front of you?
[CUSTOMER][NEUTRAL] Just a moment. Uh, I got the policy number. It's 02.
[CUSTOMER][NEUTRAL] 33
[CUSTOMER][NEUTRAL] 46
[CUSTOMER][NEUTRAL] 49.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And verify that patient's date of birth.
[CUSTOMER][NEUTRAL] Patient's date of birth is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you and you say you're calling for claim status correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] For [PII], but the total charges of $507 even.
[AGENT][NEUTRAL] OK, one moment. And do you have the balance, uh, never on. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I said the amount was 507.
[AGENT][NEUTRAL] Um one moment.
[AGENT][NEUTRAL] And you're calling from?
[CUSTOMER][NEUTRAL] Corbell Health.
[CUSTOMER][NEUTRAL] You could also see the Beaumont Hospital.
[AGENT][NEUTRAL] Uh, don't show we received that claim. Can you verify the mailing address it was submitted to?
[CUSTOMER][NEUTRAL] Um, I have the claim number. Um, should I provide you that?
[AGENT][NEUTRAL] OK, what is the claim number?
[CUSTOMER][NEUTRAL] Um, just a moment.
[CUSTOMER][NEUTRAL] It's 33,270.
[CUSTOMER][NEUTRAL] 25
[AGENT][NEUTRAL] I see Beaumont Laboratories as the name on this claim.
[CUSTOMER][NEUTRAL] Yes. Mhm.
[AGENT][NEUTRAL] And it processed as its policy covers treatment by a physician for a covered sickness in the physician's office, clinic, urgent care facility, or emergency room. According to the information on file, services were not rendered in a covered place of service. Therefore, benefits are not payable.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] So just like the place of service is not covered, right?
[AGENT][NEUTRAL] That is not a covered place of service. As I stated the claim process, this policy covers treatment by a physician for a covered sickness in an outpatient or a physician's office, clinic, urgent care facility, or emergency room. According to the information on file, services were not rendered in a covered place of service. Therefore, benefits are not payable.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] 17th. All right, thank you so much. And when it was denied?
[AGENT][NEUTRAL] Uh, this claim processed on.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, claim processed on [PII].
[CUSTOMER][POSITIVE] All right. Thank you so much for that. And may I have the call reference number?
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] Uh, reference number.
[AGENT][NEUTRAL] Uh, if you like, you may use my name in today's date.
[CUSTOMER][NEUTRAL] All right. And sorry, I, could you please spell your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] All right, thank you so much for that and have a good day, [PII].
[AGENT][POSITIVE] Alright, you're welcome, [PII]. Thanks for calling APL bye.
[CUSTOMER][NEUTRAL] Bye.