AccountId: 011433970860
ContactId: fe92f70f-9619-45fe-a0e7-b4bb4a0030e1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 228179 ms
Total Talk Time (AGENT): 84559 ms
Total Talk Time (CUSTOMER): 59500 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/fe92f70f-9619-45fe-a0e7-b4bb4a0030e1_20250213T21:08_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from the provider's office checking on our claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status. Can you repeat your name for me, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Contact number is [PII]. It's a direct line, policy number is 1967205.
[AGENT][NEUTRAL] Thank you. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Mm, only one.
[AGENT][NEUTRAL] OK, can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] and the 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. And may I have the date of service for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] [PII], total charge on the claim is $298 even.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Provider's office [PII].
[AGENT][NEUTRAL] Alright, so I'm showing that the claim was received on [PII].
[AGENT][NEUTRAL] The claim number is 354-8292.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] As office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] So will this come the patient responsibility?
[AGENT][NEUTRAL] So we don't determine patient responsibility because we're not the major medical insurance.
[AGENT][NEUTRAL] So it'll be whatever
[CUSTOMER][NEUTRAL] So can we send a crowded claim on this?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Can we send a collected claim on this? So it's, can we bill this to patients since the office visit are covered under the policy?
[AGENT][NEUTRAL] We don't determine patient responsibility. So that would be whatever your policy is for outstanding or remaining balances, whether it's a write-off bill, um, it would be whatever your company does. We, we can't determine that because we're not major.
[CUSTOMER][NEUTRAL] OK, we also don't know what we have to do based on the information you're providing only we'll take the action from my end.
[AGENT][NEUTRAL] OK. And was there anything else I could assist you with today?
[CUSTOMER][NEUTRAL] Um, OK, reference number for this call.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, which is [PII] First initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you [PII] for your assistance. I really appreciate that and have a great day bye.
[AGENT][POSITIVE] Thank you you also and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.