AccountId: 011433970860
ContactId: ebf19344-6a73-4d35-b8dd-4b91c29095c6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 273760 ms
Total Talk Time (AGENT): 98269 ms
Total Talk Time (CUSTOMER): 87384 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=2.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/ebf19344-6a73-4d35-b8dd-4b91c29095c6_20250514T20:42_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] Uh, hi, I'm [PII] calling from the provider's office to check on a claim status.
[AGENT][NEUTRAL] OK [PII], you have one.
[CUSTOMER][NEUTRAL] Could you please spell out your name?
[AGENT][NEUTRAL] It is [PII] And how do you spell your name?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you. And what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] Uh, yes, the callback number is [PII].
[AGENT][NEUTRAL] Thank you. And you have one claim to check status on, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes ma'am, I can help you with that. And what is the member's policy number please?
[CUSTOMER][NEUTRAL] Yes. Uh, it's uh 022.
[CUSTOMER][NEUTRAL] 301
[CUSTOMER][NEUTRAL] 01
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[AGENT][NEUTRAL] And any information provided to you today [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, uh, the patient's first name is [PII] and the last name is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And her date of birth?
[CUSTOMER][NEUTRAL] Yes, the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And what is the date of service and total bill amount?
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII]. And the total charges is $214.08.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK [PII], so this claim was received. It was received on 48.
[AGENT][NEGATIVE] It was processed and denied on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 358.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 772 7
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Reason for the denial states office visits are not covered by the above numbered policy. The members supplemental policy does not cover office visits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you for that.
[AGENT][NEUTRAL] You're welcome. And [PII], if you need a copy of this explanation of benefits now that you have the claim number, you can print it.
[AGENT][NEUTRAL] By going to our portal which is located at secured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Thank you for that. Uh, just a second. I, uh, I need to verify some of the details. Uh, can I place your call on hold for a few moments? Just 2 minutes.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, thank you for your patience. Uh, can I get a call reference number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][POSITIVE] OK, thank you. Thank you so much.
[AGENT][POSITIVE] OK, you're welcome. Yes ma'am. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] Have a great day.
[CUSTOMER][POSITIVE] No. Thank you so much for your.
[AGENT][POSITIVE] OK, [PII], well then, thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a nice day.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Have a great day.
[AGENT][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye-bye.