AccountId: 011433970860
ContactId: f5a31ad4-379a-4859-8575-fca37224ff00
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 514640 ms
Total Talk Time (AGENT): 176606 ms
Total Talk Time (CUSTOMER): 96730 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/f5a31ad4-379a-4859-8575-fca37224ff00_20250414T14:21_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from Prada's office to check on a claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status and, and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah. Policy number 01748900 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] Thank you for that. And [PII], how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Yeah, I have 2 claims.
[AGENT][NEUTRAL] Alright, and can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, member name [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service and the total bills for the claim?
[CUSTOMER][NEUTRAL] Yeah, date of service [PII]. bill amount $459 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And that was [PII] for [PII].
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][NEUTRAL] OK, I just want to make sure because I'm not showing a claim on file for the member. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, well, the policy that you gave termed on [PII]. Let me see if there's an active policy. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so the active policy is policy number 2475983.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] This policy has been active since.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Uh, we did receive a claim, uh, [PII].
[AGENT][NEUTRAL] Claim number is 357-517-9.
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered on this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. OK. By the way, may I know the member's policy?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um, hold on one moment.
[AGENT][NEUTRAL] Since the Medin supplemental gap insurance?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, no, thank you for the information. I have one more thing. Can you please repeat that?
[AGENT][NEUTRAL] Sure, is it the same member or a different member?
[CUSTOMER][NEUTRAL] Yeah, it's a different number. One second.
[CUSTOMER][NEUTRAL] Yeah, it's a different number.
[AGENT][NEUTRAL] OK, hold on one moment, let me note this policy.
[AGENT][NEUTRAL] OK, the next member's policy number?
[CUSTOMER][NEUTRAL] Yeah, policy number 01616952 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] All right. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, member name [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] Yeah, date of service, [PII]. Bill amount $974 even.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] OK, so this policy termed on [PII]. Let me see if there's an active policy. Hold on one moment.
[AGENT][NEUTRAL] And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Holy Cross Medical Group.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so the active policy number is 2538061.
[AGENT][NEUTRAL] This policy has been active since [PII].
[AGENT][NEUTRAL] I'm showing the claim was received on, oh, hold on one second.
[AGENT][NEUTRAL] The claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 357-5303.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And on [PII], I'm sorry?
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah.
[AGENT][NEUTRAL] On [PII], the claim was denied.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Code 99213 was denied because office visits are not covered by this policy.
[AGENT][NEGATIVE] Code 20,610 and J as in juice 3301 were both denied because the service is not covered when performed in the doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK. For this patient, may I know the plans that, please?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] This is their Medin supplemental gap insurance.
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][POSITIVE] OK. And now, thank you for the information.
[CUSTOMER][NEUTRAL] Yeah, by the way, may I have your uh last name initial, please?
[AGENT][NEUTRAL] Yes, the first initials of my last name is [PII].
[CUSTOMER][POSITIVE] You know, thank you for the valuable information. Can I get the call reference number, please?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name at today's date.
[CUSTOMER][POSITIVE] Yeah, no, thank you for the information. Have a nice day.
[AGENT][NEUTRAL] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, no, no, thank you.
[AGENT][POSITIVE] All right, thanks for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.