AccountId: 011433970860
ContactId: f128379f-4395-477c-bf82-dac8aa2499d5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 344519 ms
Total Talk Time (AGENT): 97259 ms
Total Talk Time (CUSTOMER): 135148 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/f128379f-4395-477c-bf82-dac8aa2499d5_20250117T17:59_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Michigan Healthcare Professionals. I'm calling to check on a claim status.
[AGENT][NEUTRAL] OK ma'am, can I get a good call back number?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, thank you ma'am can I get the policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is 023-31156.
[AGENT][NEUTRAL] OK, thank you. um, can you confirm the insured's name and date of birth for me?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. And birth date is [PII].
[AGENT][NEUTRAL] OK, thank you and you said you're calling to check claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, give me just a second.
[AGENT][NEUTRAL] Uh, bear with me.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][NEUTRAL] OK, what is that data service and build amount?
[CUSTOMER][NEUTRAL] It is 920-2023 and the amount, it is $90.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] It seems like uh I don't know if you guys get the claim or not.
[AGENT][NEUTRAL] Let's see here.
[AGENT][NEUTRAL] You said $90?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Or is it 190?
[CUSTOMER][NEUTRAL] So let me check I can uh.
[CUSTOMER][NEUTRAL] 0, 190. Is this the um.
[CUSTOMER][NEUTRAL] The $40 was it paid. OK, it's $190.
[CUSTOMER][NEUTRAL] Oh, no, no, I'm sorry. I understand that this is a lot of.
[AGENT][NEUTRAL] OK, I think it's.
[CUSTOMER][NEUTRAL] Let me verify that.
[CUSTOMER][NEUTRAL] 3920, it is a partial paid um.
[AGENT][NEUTRAL] OK, do you know how much the exact bill amount was? Because it looks like we do have a claim on file, but it looks like it's a little bit more than what you're saying.
[CUSTOMER][NEUTRAL] OK. Uh, let me see.
[CUSTOMER][NEUTRAL] I'm just gonna go back to the 2023.
[CUSTOMER][NEUTRAL] 92
[CUSTOMER][NEUTRAL] Showing $280.
[AGENT][NEUTRAL] OK, I just wanted to make sure.
[CUSTOMER][NEUTRAL] No, I, I found it.
[CUSTOMER][NEGATIVE] It's partial uh partially paid, and I think it's $90 wasn't paid.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, let's see here.
[AGENT][NEUTRAL] OK, so I have the claim number. Do you have that on file or do you need that?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I have the, uh, I have the claim number with the um.
[CUSTOMER][NEUTRAL] You let me verify it claim number.
[AGENT][NEUTRAL] OK, are you calling about the two codes that wasn't paid?
[CUSTOMER][NEUTRAL] If you can just.
[CUSTOMER][NEUTRAL] Yes, it is the 90690686 CVC code and [PII].
[AGENT][NEUTRAL] OK, so let me take a look here. Give me just a second.
[CUSTOMER][NEUTRAL] I said they.
[AGENT][NEUTRAL] OK, so the 90471, that was denied because vaccinations are non-covered under the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, no covered.
[CUSTOMER][NEUTRAL] Um, what about the 90686?
[AGENT][NEGATIVE] And that was denied because on the 9903 the max benefits have been paid for that data service so that's why the 90686 was denied.
[CUSTOMER][NEUTRAL] Oh, I'm sorry, what was that be?
[AGENT][NEUTRAL] Um, the max benefits have been paid for the data service for the 99203, yes ma'am.
[CUSTOMER][POSITIVE] How much benefits, uh, yes.
[CUSTOMER][NEUTRAL] Tax benefits paid for that.
[CUSTOMER][NEUTRAL] For the 9903.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Yeah, got you.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I'm just reading the notes here. I don't know why it's still here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it hasn't been press.
[AGENT][NEUTRAL] Ma'am.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] All right, and may I have a reference number?
[AGENT][NEUTRAL] I'm sorry, could you
[AGENT][NEUTRAL] It's gonna be my name, [PII], with the first initial to my last name, [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, I'm sorry, I was just reading the notes on the claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you so much for your help.
[AGENT][NEUTRAL] OK, is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Alright bye.
[CUSTOMER][NEUTRAL] Um, I think that's it. Gonna, uh, know why they deny why the claims denied and just need a reason. OK, thank you so much.
[AGENT][POSITIVE] OK, well thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] You too as well have a good weekend.
[AGENT][POSITIVE] Alright alright you too bye bye.