AccountId: 011433970860
ContactId: fef5a0d8-7b82-4a7c-95f2-3cb1fb7e963c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 320589 ms
Total Talk Time (AGENT): 78890 ms
Total Talk Time (CUSTOMER): 71532 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/fef5a0d8-7b82-4a7c-95f2-3cb1fb7e963c_20250328T17:28_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from an agent's office.
[CUSTOMER][NEUTRAL] And I wanted to know if I could check on a claim for a member.
[AGENT][NEUTRAL] OK, how do you spell your name?
[CUSTOMER][NEUTRAL] My name
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] And you're with the broker's office?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[AGENT][NEUTRAL] And do you have a callback number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Uh, what they, the member's policy number, what they wrote was 01762203ML8.
[AGENT][NEUTRAL] Thank you, hold on one moment please.
[AGENT][NEUTRAL] And who's the patient?
[CUSTOMER][NEUTRAL] Um, the patient.
[CUSTOMER][NEUTRAL] Its [PII].
[AGENT][NEUTRAL] And her date of birth?
[CUSTOMER][NEUTRAL] Her date of birth is [PII].
[AGENT][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] And you were needing claim status?
[CUSTOMER][NEUTRAL] Yes, just checking up on that checking up on it for her.
[AGENT][NEUTRAL] OK, I can help you with that. What date of service?
[CUSTOMER][NEUTRAL] OK, let me look down.
[CUSTOMER][NEUTRAL] Uh, looks like it was [PII] of this year.
[AGENT][NEUTRAL] Hold on one moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on just a moment. I'm trying to pull the claim up.
[AGENT][NEGATIVE] OK, I'm showing we received it, but it was denied as she don't have the OTR rider benefit on her policy.
[CUSTOMER][NEUTRAL] OK, what, um.
[CUSTOMER][NEUTRAL] What's the OTR writer?
[AGENT][NEUTRAL] The um service is done in a doctor's office.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] So if it was done outpatient or anything, we would need a billing from that facility saying it was outpatient.
[AGENT][NEUTRAL] Because what we got from her is just an explanation of benefits from her primary.
[AGENT][NEUTRAL] And it just looks like it was done in the office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Interesting because I saw I saw that they did have that.
[AGENT][NEUTRAL] She has outpatient, she has the lab rider, but I don't see the.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OTR writer.
[AGENT][NEUTRAL] Or office visit rather.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] All right uh thank you very much.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, no, that's it.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You have a good day.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][NEUTRAL] Mhm. Bye bye.