AccountId: 011433970860
ContactId: e1522596-da06-4d58-b250-f8fde2e26ff3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 333899 ms
Total Talk Time (AGENT): 135616 ms
Total Talk Time (CUSTOMER): 66410 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/e1522596-da06-4d58-b250-f8fde2e26ff3_20250521T18:36_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi [PII]. I am calling to, um, check on the status of a claim.
[AGENT][NEUTRAL] OK, you have a one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yes. Mhm.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] I'm so sorry. Can you give me your name again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, [PII], thank you. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] Policy number is 2175428.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] Compiling the information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the bill amount is $1,0001 with 1 cent.
[AGENT][NEUTRAL] 1001.01. Is that correct?
[CUSTOMER][NEUTRAL] Yes. Mhm.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this claim was received on 9-25-24?
[AGENT][NEUTRAL] And it was processed on [PII].
[AGENT][NEUTRAL] The claim number is 351.
[AGENT][NEUTRAL] 0971.
[CUSTOMER][NEUTRAL] I'm, I'm sorry, you said 351?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 0971.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] This claim was denied?
[AGENT][NEUTRAL] One of the denial reasons state policy provides no benefits for the treatment of conditions other than a sickness or injury as defined by the policy.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Another denial code states the service is not covered when performed in a doctor's office or clinic.
[AGENT][NEUTRAL] And the last remarks states office visits are not covered by the above numbered policy.
[CUSTOMER][NEUTRAL] OK. Um, is there any way you could send me that EOB?
[AGENT][NEUTRAL] Yes, and you can also print it from our portal if you go to [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Yes, ma'am, but I will fax this one to you.
[AGENT][NEUTRAL] Until you can set up your profile.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh, do you need the fax number?
[AGENT][NEUTRAL] In just a moment. I've got to get the EOB pulled up. Mhm.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][NEUTRAL] Does it need to have your name on the fax, [PII], or is that not necessary? No? OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, no, not necessary, mhm, I'm sorry, what is your name again?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. Sorry about that, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what is your fax number, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and I'm just gonna repeat that back. [PII].
[CUSTOMER][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] OK. Well, I have just faxed that to you, so you should be receiving that shortly.
[CUSTOMER][POSITIVE] Oh, thank you very much, [PII]. I appreciate your help. You have a good day.
[AGENT][POSITIVE] Oh, you're very welcome. Yes, ma'am. I hope you do too, [PII]. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, no, that's it thank you.
[AGENT][POSITIVE] OK, well, you're welcome and thank you again for calling APL.