AccountId: 011433970860
ContactId: e61b0b9c-acf9-4ef0-8ae1-57a411344ffc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 315769 ms
Total Talk Time (AGENT): 106251 ms
Total Talk Time (CUSTOMER): 82279 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/e61b0b9c-acf9-4ef0-8ae1-57a411344ffc_20250404T15:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. Last name in [PII] and I'm calling from the provider's office. Can you help me with the claim status?
[AGENT][POSITIVE] Yes, I can check on a claim for you. [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII], with the extension [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yeah, policy number is 60801.
[AGENT][NEUTRAL] That is our payer ID, uh, that's not a policy number, uh, if you don't have that I can start using their social if you have that.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I don't have the social. I have the member's name and date of birth. Can you start it with that?
[AGENT][NEUTRAL] Um, if you wouldn't mind spelling out the first and last name for me.
[CUSTOMER][NEUTRAL] Yes, it's uh [PII]. And the last name initial last name is [PII]. It's [PII].
[AGENT][NEUTRAL] OK all right thank you one moment.
[AGENT][NEUTRAL] And did did you have uh the date of birth for this number?
[CUSTOMER][NEUTRAL] Yes, the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you for that. I did find this policy. I can give you that correct policy number whenever you're ready.
[CUSTOMER][POSITIVE] Yes, I'm ready.
[AGENT][NEUTRAL] That's 02406368.
[CUSTOMER][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] And then what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] and then uh what was that bill amount please?
[CUSTOMER][NEUTRAL] Bill amount is, just give me a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Bill amount is $94.95.
[AGENT][NEUTRAL] OK, thank you. One moment please.
[AGENT][NEUTRAL] OK, so we did receive this claim, [PII], we were unable to pay a benefit as durable medical equipment is not covered under this policy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Just give me a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] Just allow me a second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Uh, OK. Thank you so much. Can you submit appeal for this one?
[AGENT][NEUTRAL] Um, you can, um, DME is not a covered benefit under this policy, but you are more than welcome to submit an appeal. It just has to be submitted to us within 180 days of the process date, and that was [PII].
[CUSTOMER][NEUTRAL] May I know when you receive this claim?
[AGENT][NEUTRAL] Um, we received it [PII]. It was processed [PII].
[CUSTOMER][NEUTRAL] OK. May I have the claim number as well?
[AGENT][NEUTRAL] That is 357-026-3.
[CUSTOMER][NEUTRAL] So you mean the provider is out of network with this plan?
[AGENT][NEUTRAL] No, it has no DME is just not a covered benefit under this policy.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[CUSTOMER][NEUTRAL] Can I have the call reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] No, no. Thank you so much. Have a great day. Bye-bye. Happy weekend.
[AGENT][POSITIVE] Of course, thanks for that [PII] you too thank you bye bye.