AccountId: 011433970860
ContactId: d9067464-41b6-4ad6-907c-4208b515eaf9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 256500 ms
Total Talk Time (AGENT): 113496 ms
Total Talk Time (CUSTOMER): 110110 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/d9067464-41b6-4ad6-907c-4208b515eaf9_20250311T18:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah. Hi, [PII]. My name is [PII]. Uh, I'm calling from provider's office. I'm checking on a claim status.
[AGENT][NEUTRAL] Sure, I could check on a claim for you. um, I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] It's [PII]. That's uh [PII].
[AGENT][POSITIVE] Got it. OK, thank you and then uh can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] It's uh [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Uh, yes, I do. The policy number is uh
[CUSTOMER][NEUTRAL] 02413470 M as in Mike, L as in Larry, number 8.
[AGENT][NEUTRAL] OK and uh what was the name and date of birth for the insured please?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that [PII]. Uh, what was the date of service for this claim?
[CUSTOMER][NEUTRAL] It's for [PII].
[AGENT][NEUTRAL] [PII], OK, and then do you have the bill amount?
[CUSTOMER][NEUTRAL] But $459 459.
[AGENT][POSITIVE] Got it thank you one moment please.
[AGENT][NEUTRAL] Was this for a Holy Cross Medical Group?
[CUSTOMER][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so I did find this claim. Uh, we were unable to pay a benefit as office visits are not covered under this policy, nor as treatment or excuse me, services received in office are not uh covered either.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Yeah. So, office, you're saying like uh office visits are not covered for this patient plan, right?
[AGENT][NEUTRAL] Correct, yes, and if you'd like I can send you a copy of this EOB.
[CUSTOMER][NEUTRAL] Uh, yeah, can you send me, I mean, like, can you provide me when this claim received and denied?
[AGENT][NEUTRAL] Oh sure, one moment, let me get that.
[AGENT][NEUTRAL] OK, so this claim was received [PII].
[AGENT][NEUTRAL] And it was processed [PII].
[CUSTOMER][NEUTRAL] [PII]. And do you have the claim number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, that claim number is 3,561,770.
[CUSTOMER][NEUTRAL] 170. And just one last information. So this plan is not covered under member's plan. So, what is the member's plan type?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Sure, this is a secondary medical policy. So it is supplemental.
[CUSTOMER][NEUTRAL] Yes, secondary medical policy supplemental. Yeah, sure, then. Can you send that to you for me?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Of course, do you have a fax number?
[CUSTOMER][NEUTRAL] Yeah. The fax number is [PII]. Uh, can you repeat that? I mean, like once you got correct one?
[AGENT][NEUTRAL] OK, yes, absolutely, I wanna make sure I heard that right, so that was [PII]?
[CUSTOMER][NEUTRAL] Yes, and the attention, you can, you can add my name, Avi.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, got it. Alrighty, I will get that sent to you now. Uh, you should get it within, uh, maybe 10-15 minutes. Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And just help me with like a call reference number.
[AGENT][NEUTRAL] Sure, uh, that would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII]
[CUSTOMER][NEUTRAL] It's [PII]?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] All right. You know, thank you for helping me with this information.
[AGENT][POSITIVE] Of course, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] And you too have a great day. Bye now.
[AGENT][POSITIVE] Thank you. Bye-bye.