AccountId: 011433970860
ContactId: ea09a018-2dd6-42cd-86b0-f39d630534d8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 220559 ms
Total Talk Time (AGENT): 93629 ms
Total Talk Time (CUSTOMER): 82698 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/ea09a018-2dd6-42cd-86b0-f39d630534d8_20241230T15:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check the claim status.
[AGENT][NEUTRAL] OK, yeah, I can check on a claim for you. I'm sorry, you said your name was [PII]?
[CUSTOMER][NEUTRAL] Yes, sorry?
[AGENT][NEUTRAL] Did, did you say your name was [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, I have a policy number with me. It's uh 01930316.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Yeah. Patient's name, [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII]. Uh, what was the date of service for this claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, [PII] and total bill amount is $1,042 even.
[AGENT][NEUTRAL] OK, uh, so this policy that you gave me terminated, uh, [PII]. Give me one moment, let me see if they had one active at that time.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, they did give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh, I'm sorry, [PII], what was the name of the, uh, provider's office you're with?
[CUSTOMER][NEUTRAL] Orthopedic Institute of North Mississippi.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEGATIVE] Alright, so I did find this claim, [PII], uh, we were unable to pay a benefit. Office visits are not covered under this policy, and none of the services.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, on this claim are gonna be covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, can I get the claim number?
[AGENT][NEUTRAL] Yes, claim number is 351-6995.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, may I know the patients have, uh, HMOP, uh,
[CUSTOMER][NEUTRAL] I know, uh, the primary insurance BCBS is a PPO plan, um, and the patient have a PPO plan as a primary. Can you reprocess the claim?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, they're not covered office visits and procedures covered in office are not covered under this policy, so this one is their secondary medical. It is more of a supplemental plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, thank you. May I have your name, please?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Yes, it's [PII]
[AGENT][NEUTRAL] My last initial is [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can I get the term date of this uh coverage?
[AGENT][NEUTRAL] This policy is currently active and it is a different policy number than you gave me, [PII]. Would you like me to give you this active one?
[CUSTOMER][POSITIVE] No. Thank you. Thank you for your assistance. Have a good day. Bye-bye.
[AGENT][NEUTRAL] Yeah, was there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] OK, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, bye bye.