AccountId: 011433970860
ContactId: 00e85d6c-3169-49dd-b745-f6b74372f71b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1542819 ms
Total Talk Time (AGENT): 172891 ms
Total Talk Time (CUSTOMER): 136788 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-2.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/00e85d6c-3169-49dd-b745-f6b74372f71b_20250211T14:58_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office.
[CUSTOMER][NEUTRAL] Checking on a claim status.
[AGENT][NEUTRAL] OK, sure, Mr. [PII], I can assist you with claim status.
[AGENT][NEUTRAL] And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Callback number is
[CUSTOMER][NEUTRAL] [PII]. My extension direct line?
[AGENT][NEUTRAL] OK, and where are you calling from?
[CUSTOMER][NEUTRAL] Gastrohealth.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] May I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Sounds good.
[CUSTOMER][NEUTRAL] Yeah, the policy number is 023.
[CUSTOMER][NEUTRAL] 04876.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah. My name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] All right, thank you. And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of service is [PII] and total charges of $410 even 410.
[AGENT][NEUTRAL] OK, and that's [PII], correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. Thank you. One moment.
[AGENT][NEUTRAL] And for the future, you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] But from S to once the portal is not responding, we are unable to download the UOB sphere.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's $50 right?
[AGENT][NEUTRAL] All right, we processed the claim, we received the claim on [PII], um, processed the claim on [PII], and then the claim was denied. The reason for this denial is that office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] OK, can I have a claim number?
[AGENT][NEUTRAL] Sure, that is 343-075-4.
[CUSTOMER][NEUTRAL] Thank you. Can you fax me the UV?
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, um, do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEGATIVE] Yeah, sure, but previously we have requested 3 times, but we haven't received the UB.
[AGENT][NEUTRAL] I'm sorry, I can only try to send it to you. Um, Mr. [PII], what is um the spelling of your name or do to what attention do I put this?
[CUSTOMER][NEUTRAL] The spelling of my name is [PII].
[AGENT][NEUTRAL] OK, thank you. One moment, let me put you on hold so I can send this right now.
[CUSTOMER][NEUTRAL] Yeah, can you spell your name for my documentation.
[AGENT][NEUTRAL] Sure, that's [PII]. That's initial [PII].
[AGENT][NEUTRAL] hold so I can send this. OK, one moment.
[CUSTOMER][NEUTRAL] So much.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. Yeah, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I have one more claim. Can you pull information for me?
[AGENT][NEUTRAL] Is it a different member or same member?
[CUSTOMER][NEUTRAL] Different number?
[AGENT][NEUTRAL] OK, and what is the next policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] 02312635 M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] OK one moment.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Member's name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of service is [PII] and total charges of $358 even 358.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, it's [PII], correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, we received the claim [PII], processed the claim [PII], and the claim was denied as office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK, can I have a claim number?
[AGENT][NEUTRAL] Claim number is 354-7125.
[CUSTOMER][NEUTRAL] Thank you. Can you fax me the COB also?
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I'm gonna put you on a brief hold, OK? One moment.
[CUSTOMER][NEUTRAL] As the.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me. Yeah, I went ahead and send that one as well. Is there anything else I may help you with today?
[CUSTOMER][NEGATIVE] Yeah, but I haven't received the first now.
[AGENT][NEUTRAL] OK, it might take a little bit. You gave me number [PII]. Is that correct?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I did send it to that fax number, um, and that's the only thing I can do. I can only send it and um usually again you need to wait at least 15 minutes to see if you get it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. Can I have the call reference number?
[AGENT][NEUTRAL] It's gonna be my name in today's date. We don't have reference numbers.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Have a great day.
[AGENT][POSITIVE] You as well thank you for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] But this one now.