AccountId: 011433970860
ContactId: e682e2b3-d945-40c0-9bee-d50e845f6503
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 282540 ms
Total Talk Time (AGENT): 71530 ms
Total Talk Time (CUSTOMER): 57646 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/2025/01/31/e682e2b3-d945-40c0-9bee-d50e845f6503_20250131T16:19_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Yes, this is [PII] calling from Unity Health Network and I was checking to see if a member had coverage in September.
[AGENT][POSITIVE] I'll be happy to assist with eligibility today you said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, and if I can get a good call back number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] 01888537
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is active and it's been effective since [PII], so they were covered in September.
[CUSTOMER][NEUTRAL] OK, so do I have to go to a different department to find out if you have a claim?
[AGENT][NEUTRAL] No, I can help you. What's the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your tax ID?
[CUSTOMER][NEUTRAL] Uh, hold on just a
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. I do show we received the claim. The claim was denied because office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] OK, you don't, you don't send out denials for that reason?
[AGENT][NEGATIVE] No, we sent a denial. We sent it to Unity Health Network address [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. That's where the EOB went.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] They didn't post it. OK, is there any way you could fax me a copy of that?
[AGENT][NEUTRAL] OK, and what's that fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Extension [PII].
[AGENT][NEUTRAL] OK, you should receive that fax in the next 5 to 7 minutes. Was there anything else I can assist with today?
[CUSTOMER][NEUTRAL] Uh, when did you say that denial was? What day?
[AGENT][NEUTRAL] One moment.
[AGENT][NEGATIVE] We received that claim on [PII] and the denial went off [PII].
[CUSTOMER][NEUTRAL] Do you have call reference numbers?
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call.
[CUSTOMER][POSITIVE] OK, thank you very much that's all I needed.
[AGENT][POSITIVE] Thank you for calling APL have a good day.