AccountId: 011433970860
ContactId: f73613b3-ab5a-4538-82bf-adc26aa6e704
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 474839 ms
Total Talk Time (AGENT): 158173 ms
Total Talk Time (CUSTOMER): 97983 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/f73613b3-ab5a-4538-82bf-adc26aa6e704_20250313T15:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes [PII], my name is [PII] calling from A upstate. I don't know if I picked the wrong one, but it's benefits in the car slash Coventry. Did I choose the wrong option?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, what, what did you need help with today?
[CUSTOMER][NEUTRAL] Um, I'm calling. I have a, um, last time I called they gave me the claim number, the date it was received, and how much it's gonna pay, but they did not have a check check information yet.
[AGENT][NEUTRAL] OK. All right, we can definitely check on a claim and see if we have a check number for that. Um, do you still have that claim number handy or the policy number?
[CUSTOMER][NEUTRAL] Yes ma'am, uh huh, the claim number is 2025.
[CUSTOMER][NEUTRAL] 01221094
[CUSTOMER][NEUTRAL] For [PII].
[AGENT][NEUTRAL] Alright, let me take a look here.
[AGENT][NEUTRAL] All right, [PII], that didn't come up. Can you give me [PII]'s policy number? Do you have that?
[CUSTOMER][NEUTRAL] Yes, um, let's see here, ID number is D as in dog 43732166.
[AGENT][NEUTRAL] First name is [PII], correct? Last name [PII]?
[CUSTOMER][POSITIVE] Yes ma'am, yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is his date of birth?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] That number unfortunately doesn't pull up their policy on our side, the D number, so let me try by his name.
[AGENT][NEUTRAL] And was it a medical claim or a dental claim?
[CUSTOMER][NEUTRAL] It was a medical claim.
[AGENT][NEUTRAL] OK, data service.
[CUSTOMER][NEUTRAL] Data services for [PII] for $514.02.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 2
[AGENT][POSITIVE] Alright, let me just check the amount on this claim here. I appreciate your patience.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so the claim number that I show on our side, we did receive a claim for that date of service and that billed amount um I'm showing that the claim was denied it looks like you said that they had said there was a payment made.
[CUSTOMER][NEUTRAL] Mhm for $371.77 and the patient had a co-pay of $10.
[AGENT][NEUTRAL] And the claim number that you have is the 202501221094?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] I wonder if the insured has a different insurance because the claim number I have is 3559452.
[CUSTOMER][NEUTRAL] No, um, let me see something.
[CUSTOMER][NEUTRAL] Uh, who gave me that.
[CUSTOMER][NEUTRAL] T.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Mm, that's what I have, so that's not correct?
[AGENT][NEGATIVE] Yeah, I mean that's not our claim number and I don't show that any payment was made on this claim that I gave you. It shows it was denied.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] The outpatient writer only allows payment for outpatient surgery in a hospital or physician office, so there was no benefit payable.
[AGENT][NEUTRAL] And it looks like it also states it denied that vaccines and immunizations are not covered benefit under this policy.
[CUSTOMER][NEUTRAL] OK, now, um, and I also have that this claim with did y'all receive this claim on [PII]?
[AGENT][NEUTRAL] Hm.
[AGENT][NEGATIVE] Not seeing anything.
[AGENT][NEGATIVE] Yeah, I mean this was the only thing that I show received reported on and it was in [PII] of this year. I don't show anything for December received.
[CUSTOMER][NEUTRAL] OK, can I have that claim number?
[AGENT][NEUTRAL] Absolutely, uh, the claim number is 3559452.
[AGENT][NEUTRAL] And if you need, I can also fax a copy of the EOB.
[CUSTOMER][POSITIVE] Yes, ma'am, if you don't mind.
[AGENT][NEUTRAL] No, not at all. What's a good fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Should I mark that attention to you?
[CUSTOMER][NEUTRAL] Yes, ma'am. [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And just to confirm it was [PII], correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] OK. That should be there in about 5 minutes, so, uh, just give it a few. No, no problem. Anything else I can help with?
[CUSTOMER][POSITIVE] Appreciate it thank you.
[CUSTOMER][POSITIVE] That'll be all. You have a great one.
[AGENT][NEUTRAL] You too. Bye bye.