AccountId: 011433970860
ContactId: dceebb22-c7ff-4347-a27b-a1e696839796
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 267399 ms
Total Talk Time (AGENT): 142461 ms
Total Talk Time (CUSTOMER): 89039 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/dceebb22-c7ff-4347-a27b-a1e696839796_20250429T14:45_UTC.wav
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[AGENT][NEUTRAL] Contacting APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII], and I'm calling from provider offers for the same status.
[AGENT][POSITIVE] You sure I can certainly help with the claim status. What's that policy number, please?
[CUSTOMER][NEUTRAL] Um, the policy number is
[CUSTOMER][NEUTRAL] 02349132.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII], and it's date of birth is Sep uh it's [PII].
[AGENT][POSITIVE] OK, thank you so much. Um, is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's uh [PII].
[AGENT][NEUTRAL] OK, thank you. And what date of service are we looking for for [PII]?
[CUSTOMER][NEUTRAL] Uh, meanwhile, could you please just, uh,
[CUSTOMER][NEUTRAL] Tell me your good name?
[AGENT][NEUTRAL] Yes, it's [PII], it's [PII] and we're gonna use that in today's date as our reference.
[CUSTOMER][NEUTRAL] OK. And first name should do you last?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] OK, so the data service is
[CUSTOMER][NEUTRAL] [PII] with total charges $1,893.69.
[AGENT][NEUTRAL] Thank you. Your claim number for this is 34618.
[AGENT][NEUTRAL] 30.
[AGENT][NEUTRAL] Now, the um
[AGENT][NEUTRAL] Let me just check here really quickly. It looks like the claim.
[AGENT][NEUTRAL] It is, uh, for, um, health services. It, it looks like it's for like a routine wellness uh encounter for screening, um, just sort of a routine wellness type of, of a claim. And this policy only covers accident or sickness. And so this claim was denied because it's not for accident or sickness. It looks like it's just for a routine wellness claim.
[AGENT][NEUTRAL] And uh let me just check and see. It looks like we received that claim.
[AGENT][NEUTRAL] Alright, there's a bunch of them here.
[AGENT][NEUTRAL] Uh, it looks like we received the claim on the [PII].
[AGENT][NEUTRAL] [PII] and we processed it on the [PII].
[AGENT][NEUTRAL] [PII], but, but the policy that the claim was denied.
[AGENT][NEUTRAL] Um, because the, uh,
[AGENT][NEUTRAL] The claim wasn't for an accident or sickness.
[CUSTOMER][NEUTRAL] OK. So you only cover the accidental uh coverages, right?
[AGENT][NEUTRAL] That's right, yes. Accidents or sickness, this is not, this is not a wellness, uh, policy. So, uh, they weren't able to cover, they weren't able to cover that, uh, because it was, uh,
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It wasn't for, it wasn't for that. It looks like it's just for routine checking.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK, OK. So you, uh, you don't uh coverage, uh, cover the accident uh claims, right?
[AGENT][NEUTRAL] Yeah, we only do accident sickness. That's it.
[CUSTOMER][NEUTRAL] OK, so, uh, in this scenario, patient himself responsible to upail the services, right? That is all the patient responsibility.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] Well, I can't really tell you that. The only thing I can tell you is that the policy doesn't cover it. So they may very well have another policy. This, this is just a secondary insurance. So it's it's very likely that they have another policy. So you, you would just need to check with them, um, but I can, the only thing I can really tell you is, is that we won't cover it.
[CUSTOMER][NEUTRAL] OK. So, uh,
[CUSTOMER][NEUTRAL] Uh-huh. OK, OK, got it. So, is there any scope, you know, you provide me, uh, another, you know, what the primary, uh, career patients have?
[AGENT][NEUTRAL] Well, the only thing I know about is just our policy, so uh there's really nothing that I could, um, that, that's really the only thing I know about. It's just the, the policy that we've got.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got it. Got it, [PII]. So at the last, could you please just uh tell me uh the date with the call reference number. Uh, I think your name is [PII], right?
[AGENT][NEUTRAL] Yes, my name is [PII], and we're gonna use that in today's date as a reference.
[CUSTOMER][POSITIVE] OK. Thank you. There is no more more questions from my side and have a wonderful day ahead.
[AGENT][POSITIVE] OK, thanks for contacting AT have a