AccountId: 011433970860
ContactId: fbf94f8f-4d0b-426b-ba7d-e4e5d2940da0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 325940 ms
Total Talk Time (AGENT): 118052 ms
Total Talk Time (CUSTOMER): 83867 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/fbf94f8f-4d0b-426b-ba7d-e4e5d2940da0_20250325T15:02_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, [PII], this is [PII]. I'm looking for a team service.
[AGENT][POSITIVE] OK, I'll be more than happy to help you with the claim status, [PII]. May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] For sure, it's [PII].
[AGENT][NEUTRAL] Thank you. May I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure, it's 231-271-2.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] For sure. It's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment.
[CUSTOMER][NEUTRAL] Hello, can you hear me?
[AGENT][NEUTRAL] Yes, can you hear me?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Yeah, I can, I can.
[AGENT][NEUTRAL] You can hear me?
[CUSTOMER][NEUTRAL] Yeah, I can hear you. Can you hear me?
[AGENT][NEUTRAL] Yes, um, so I was given the disclaimer, all the information provided.
[CUSTOMER][NEUTRAL] Yeah, I can. Can you hear me? I audible to you?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] So there seems to be a delay.
[AGENT][NEUTRAL] How may I assist you today? With the claim, what is the date of service?
[CUSTOMER][NEUTRAL] Uh, this is for [PII].
[AGENT][NEUTRAL] And what is the total bills?
[CUSTOMER][NEUTRAL] $50 even 50.
[AGENT][NEUTRAL] Thank you for that. And what is the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Uh, this is for integral rheumatology and immunology specialist for Doctor [PII].
[AGENT][NEUTRAL] OK, so we don't have a claim on file for $50. We do have a claim on file from your provider, but it's a different total bill.
[CUSTOMER][NEUTRAL] OK, can I have like, uh, what is the total bill you have for this provider for the new service?
[AGENT][NEUTRAL] Um, can you verify your tax ID just to make sure this is the same provider?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] Yeah, this bill has a, it is the same provider, same data service. This bill has a total of $329 and it's the only bill we received, but there's no other claim for just $50.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, like, can I have the status for this one?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] The 300 1.
[CUSTOMER][NEUTRAL] Can I have the status for this one because this is the only claim that we have.
[AGENT][NEUTRAL] Right, this is the only claim that we have. If this is, if this is the claim you're looking for, I can provide you with the status. I just wanted you to know it's a different total bill than what you provided me. Is this the correct claim?
[AGENT][NEUTRAL] Or does
[CUSTOMER][NEUTRAL] Yeah, this is the one. Can I have the status for this one?
[AGENT][NEUTRAL] We received it on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 3576681.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And on [PII], the claim was denied because office visits are not covered on the policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It was an add on [PII], sorry, right? [PII], sorry.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] The claim was received on [PII] and it was denied on [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And uh may I know like uh American Public Insurance is uh an active insurance for this member and is it the primary or the secondary insurance for member?
[AGENT][NEUTRAL] This is the secondary insurance.
[CUSTOMER][NEUTRAL] Yeah, the second place. OK. And yeah, can I have the claim timely filing also?
[AGENT][NEUTRAL] So there's no timely filing, you can file the claim at any time.
[CUSTOMER][NEUTRAL] OK. Can I have the caller reference number as well, you know?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Got it. Thank you so much for the information. uh Have a good day. Thanks again.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can assist you with?
[CUSTOMER][NEUTRAL] No, no, no. Thanks.
[AGENT][POSITIVE] Alright, thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Bye, thanks.