AccountId: 011433970860
ContactId: e6adcb2b-f784-44e1-85a9-1a0add2c3f44
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 279160 ms
Total Talk Time (AGENT): 109066 ms
Total Talk Time (CUSTOMER): 99673 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/e6adcb2b-f784-44e1-85a9-1a0add2c3f44_20241230T15:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from [PII]'s office to check the plan status.
[AGENT][POSITIVE] OK, [PII], I'm happy to check on a claim status for you today. Do you have the policy number?
[CUSTOMER][NEUTRAL] I have a plan number with me. Could you check with that?
[AGENT][NEUTRAL] Oh yeah, what's that number?
[CUSTOMER][NEUTRAL] It's 351-699-95.
[AGENT][NEUTRAL] Mm, I don't know if that'll bring anything up. Let me try here, one moment, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Yeah, that doesn't bring up any patients for me. Do you have their name or social? We can check that way.
[CUSTOMER][NEUTRAL] OK. Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I have a claim number with me, uh, uh, policy number with me. Could you check with that?
[AGENT][NEUTRAL] OK, what's you have the claim number, is that the claim number that you gave me, the 351?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let me try it that way. Hold on just one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have a good call back number in case we're disconnected?
[CUSTOMER][NEUTRAL] Oh, my callback number is [PII].
[AGENT][NEUTRAL] Thank you for that. And what's the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] 7
[CUSTOMER][NEUTRAL] Patient's name, [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] All right, thank you so much. So this claim that you gave me, um, I was able to pull that up. It looks like the claim was denied office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, ma'am, uh, 11 moment.
[CUSTOMER][NEUTRAL] Uh, what, what plan does patients have? It's HMO or PPO or EPOPOS?
[AGENT][NEUTRAL] Uh, neither. We are the secondary insurance, so this covers any deductible, co-pay, co-insurance, a primary does not. So this is the secondary meddling plan.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. May I have the receipt date and then date?
[AGENT][NEUTRAL] Uh, yeah, let me look that up for you. Give me just one moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, the claim was received on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Claim was processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, OK, one moment, please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, you don't know that the patients, uh, the plan that, that is kind of HMO PPO EPO. You do not, do not have the details?
[AGENT][NEUTRAL] I'm sorry, can you ask me that question again?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Patients have HMO or PPO plans?
[CUSTOMER][NEUTRAL] Uh, do you have that kind of information?
[AGENT][NEUTRAL] We do not have their primary insurance information. No, you would have to check with the insured on that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can I get the call reference for this call?
[AGENT][NEUTRAL] That's going to be my name with my last initial in today's date. My name again is [PII] spelled [PII] Last initial to my name is [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK. Thank you, sir, for your assistance. Have a good day. Thank you.
[AGENT][NEUTRAL] You too bye bye.
[CUSTOMER][NEUTRAL] One moment, please. Can I have the coverage uh and effective date for the patient?
[AGENT][POSITIVE] Yeah, absolutely.
[CUSTOMER][POSITIVE] Effective on term date, yeah.
[AGENT][NEUTRAL] So the effective date is [PII]. There is no term date. Patient is still active.
[CUSTOMER][POSITIVE] OK. Thank you for your assistance, [PII]. Have a good day. Thank you. Take care. Bye-bye.
[AGENT][NEUTRAL] You too. Bye-bye.