AccountId: 011433970860
ContactId: 031c1e09-382f-4790-b921-69117aef6870
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 287350 ms
Total Talk Time (AGENT): 94066 ms
Total Talk Time (CUSTOMER): 98199 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/031c1e09-382f-4790-b921-69117aef6870_20250106T19:37_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider's office, checking on claim status. Could you please help me with that?
[AGENT][NEUTRAL] What was your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII]. Can I have a callback number for you and the policy number of the member that you're inquiring claim status for today?
[CUSTOMER][NEUTRAL] Uh, the callback number is [PII] direct line.
[CUSTOMER][NEUTRAL] And, and you need the policy number, right?
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] Policy number is 02359663.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Could you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is.
[CUSTOMER][NEUTRAL] [PII], and the date of birth [PII].
[AGENT][NEUTRAL] And what is the date of service that you're inquiring claim status for?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] And there was no payment made on this claim? Is there several procedures lines? 12345.
[CUSTOMER][NEUTRAL] Like
[AGENT][NEUTRAL] 55 procedure lines.
[CUSTOMER][NEUTRAL] 1234566.
[AGENT][NEUTRAL] 12345.
[AGENT][NEUTRAL] OK, there was no payment made on this claim, and the reason why is because services are not covered under the policy.
[CUSTOMER][NEUTRAL] Uh, is it, um, may I know the bill amount on that claim?
[AGENT][NEUTRAL] Of the policy. It's not covered under the policy.
[CUSTOMER][NEUTRAL] OK. May I know the bill amount on that claim?
[AGENT][NEUTRAL] The bill amount on this claim.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] There is no bill amount.
[AGENT][NEUTRAL] There is no bill amount.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] And can you see that uh quotes?
[AGENT][NEUTRAL] Yes, 847-03 is one of the procedure codes.
[CUSTOMER][NEUTRAL] 847-038-748187661.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 87081810019
[AGENT][NEGATIVE] Yeah, none of these, none of them were covered under the policy.
[AGENT][NEGATIVE] The services are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. Uh, let me take a note of that.
[CUSTOMER][NEUTRAL] Non-covered under patient policy, right?
[AGENT][POSITIVE] Yes, that's correct.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] May I know the claim?
[CUSTOMER][NEUTRAL] May I know the claim received date and the denial date?
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] So let me give you the claim number, it's 3541397.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This claim was received [PII]. It was processed [PII]. There was no payment because the policy does not cover the services provided for the policy. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Could you please fax me a copy of EOB?
[AGENT][NEUTRAL] What's your fax number?
[CUSTOMER][NEUTRAL] The fax number is.
[CUSTOMER][NEUTRAL] [PII]. Attention, my name is [PII].
[AGENT][POSITIVE] Alrighty, is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Um, uh, one second, um.
[CUSTOMER][NEUTRAL] And could you please um spell me your name?
[AGENT][NEUTRAL] [PII] and today's date is a reference, [PII].
[CUSTOMER][NEUTRAL] Your name and today's date is the reference, right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] And you faxed to the EOB?
[AGENT][NEUTRAL] Yes, I'm sending it over now to [PII].
[CUSTOMER][POSITIVE] OK. Thank you for assisting. Have a nice day.
[AGENT][POSITIVE] Thanks for calling APL. You have a great one as well, [PII]. Goodbye.
[CUSTOMER][NEUTRAL] Yeah