AccountId: 011433970860
ContactId: da919c72-8c69-42d2-9ee3-72365fd2396e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 318630 ms
Total Talk Time (AGENT): 114710 ms
Total Talk Time (CUSTOMER): 113014 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/da919c72-8c69-42d2-9ee3-72365fd2396e_20250307T20:45_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling you from Health Provider Network checking on a claim status. How are you doing?
[AGENT][POSITIVE] I'm doing well. How are you?
[CUSTOMER][POSITIVE] I'm doing good. Thank you for asking.
[AGENT][POSITIVE] You're welcome and I'll be more than happy to help you with the claim status. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] was
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure, the member's ID number is
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Uh, could you please start with the social?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, could you please start with the name and date of birth?
[AGENT][NEUTRAL] Yes, I can search with the name and date of birth, or I can search with the social as well. Do you have the full social?
[CUSTOMER][NEUTRAL] Yeah, I do have. The social is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] As for the schedule.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] What's
[CUSTOMER][NEUTRAL] It on
[AGENT][NEUTRAL] And what is the member's first and last name?
[CUSTOMER][NEUTRAL] My first name is [PII] and the last name is [PII], and the date of birth is [PII].
[CUSTOMER][NEUTRAL] Can you
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] What is the.
[CUSTOMER][NEUTRAL] How many last time will be.
[AGENT][NEUTRAL] Alright, thank you so much for I'm sorry, you said the name was [PII]. Oh, the OK, um, and thank you for verifying her information. And may I have the date of service for the claim?
[CUSTOMER][NEUTRAL] Sure. The mem data service is [PII] and the bill amount is $131.16.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment while I locate the claim for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Sure, take your time.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And the total bill is $131?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And 16 cents.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so we don't have a claim on file with that total bill for the, for the data service [PII].
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] Could you please start with the claim number?
[AGENT][NEUTRAL] Does it end in 2956?
[CUSTOMER][NEUTRAL] Uh no, it's 913.
[AGENT][NEUTRAL] OK, what's the claim number you have? It must be a different policy number.
[CUSTOMER][NEUTRAL] 355-5913
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so that's processed under um policy number 2583068. Hold on one moment, let me go to that policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so the claim was received on [PII]?
[AGENT][NEUTRAL] On [PII], the claim was denied because office visits are not covered on the policy.
[CUSTOMER][NEUTRAL] So the CPT is not covered under the patient plan, right? Or the diagnosis are not covered under this plan?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] The CBD right?
[AGENT][NEUTRAL] Yes, the CPT code is not covered by the patient's policy.
[CUSTOMER][NEUTRAL] OK, just a moment, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know which plan does the patient have?
[AGENT][NEUTRAL] This is the Medin supplemental gap insurance, so we apply to the co-pay, deductible and co-insurance after primary.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So is the uh is the bill amount is the patient responsibility?
[AGENT][NEUTRAL] Um, so we don't determine patient responsibility because we're not a major medical insurance company. It would just be whatever your policy is for outstanding or remaining balances.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, no worries. Thank you so much. And can you provide the call number.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK, and there, [PII], well, you have an extreme level. I really appreciate your assistance. Have a wonderful day ahead. Thank you so much. Bye-bye bye. Take care and happy weekend.
[AGENT][NEUTRAL] Right, so how do I say?
[CUSTOMER][NEUTRAL] Right, so