AccountId: 011433970860
ContactId: ec51d247-e4d7-413c-a8fc-b3106a899add
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 325540 ms
Total Talk Time (AGENT): 130859 ms
Total Talk Time (CUSTOMER): 76697 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/ec51d247-e4d7-413c-a8fc-b3106a899add_20250409T15:53_UTC.wav
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[AGENT][POSITIVE] Good morning thank you
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling from provider's office to check on a claim status.
[AGENT][NEUTRAL] OK. [PII], you're needing to check a claim status. Is that correct?
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please, [PII]?
[CUSTOMER][NEUTRAL] That's [PII], no extension.
[AGENT][NEUTRAL] Thank you. And how many claims, [PII], do you have to check status on?
[CUSTOMER][NEUTRAL] One claim?
[AGENT][NEUTRAL] OK. And what is that your name? I can help you. What is the patient number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Give me just a place to get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information that I do provide for you today would be a verification of.
[AGENT][NEUTRAL] Benefits and not a guarantee of payment. What is your place and date of birth?
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the date of service and total bill amount, please?
[CUSTOMER][NEUTRAL] Date of service is [PII]. The amount is $336.81.
[AGENT][NEUTRAL] 336.81, is that correct?
[CUSTOMER][NEUTRAL] Yes, that's it.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I don't.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so this claim received date for this claim was [PII].
[CUSTOMER][NEUTRAL] No
[AGENT][NEGATIVE] It was processed and denied on [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The claim number, Andrea, is 355.
[CUSTOMER][NEUTRAL] On
[AGENT][NEUTRAL] 8126.
[AGENT][NEUTRAL] And the reason for the denial is that office visits are not covered by the policy.
[AGENT][NEUTRAL] Again, office visits are not covered. It's for the patient's plan.
[CUSTOMER][NEUTRAL] Is it as
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you need a copy of this explanation of benefits, you may print that now that you have the claim number by going to our portal which is located at secured.
[CUSTOMER][NEUTRAL] Um, one moment.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] I'm so sorry, [PII], you're cutting in and out. Will you please repeat that once again?
[AGENT][NEUTRAL] I said if you need
[AGENT][NEUTRAL] Need a copy of the explanation of benefits the claimer you may print that by going to excuse me, going to our portal which is located at [PII].
[AGENT][NEUTRAL] Dot
[AGENT][NEUTRAL] A
[AGENT][NEUTRAL] M public.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Got it. Thank you so much. And uh
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And this will be under the patient's responsibility, right?
[AGENT][NEUTRAL] We do not determine patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK. But uh as per patient's policy, office visits are not covered.
[AGENT][NEUTRAL] Under the supplemental policy, that is correct.
[CUSTOMER][POSITIVE] OK, thank you so much for that. And can I please have the call reference number?
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Well, you're welcome.
[AGENT][NEUTRAL] Yes ma'am, you would use my name along with today's date.
[CUSTOMER][POSITIVE] Got it and you have a great day.
[AGENT][POSITIVE] I hope you have a great day too, and that's all I can help to thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you.