AccountId: 011433970860
ContactId: 03d5dda4-14a3-4932-a1ab-34d01ff4e8f9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 312640 ms
Total Talk Time (AGENT): 96451 ms
Total Talk Time (CUSTOMER): 139792 ms
Interruptions: 4
Overall Sentiment: AGENT=1.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/03d5dda4-14a3-4932-a1ab-34d01ff4e8f9_20250318T15:30_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] Hello, my name is [PII]. I'm calling from Optum Medical Care. Calling to know the claim status. Could you please help me out?
[AGENT][POSITIVE] And it would be a pleasure to assist you with that claim status. What is the callback number please, sir?
[CUSTOMER][NEUTRAL] Hi I'm
[CUSTOMER][NEUTRAL] Yes it's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] You know I get.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Just a moment please.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] that
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] most of
[CUSTOMER][NEUTRAL] There's the just a moment.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] How do you.
[CUSTOMER][NEUTRAL] Is the policy number is 025.
[CUSTOMER][NEUTRAL] 38101.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you, [PII]. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And date of birth, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alright thank you and [PII], it would be a pleasure to assist you with that claim status. What is the data service?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And total charge amount, $2,748.
[AGENT][POSITIVE] Alright thank you I'm checking on that for you bear with me.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the facility name?
[CUSTOMER][NEUTRAL] Optum Medical Care.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] Can I'm showing that we received that claim on [PII].
[CUSTOMER][NEUTRAL] I'll be.
[CUSTOMER][NEUTRAL] How, how, how what?
[AGENT][NEUTRAL] was processed on [PII].
[AGENT][NEGATIVE] And denied as services are not covered when performed in a doctor's office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] And not like a.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK but.
[CUSTOMER][NEGATIVE] We have received the response that it was denied for claim or service not covered by despair or contractor.
[AGENT][NEUTRAL] And what claim number was that?
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEGATIVE] We got the response from the APL that it was denied as claim or service covered by another payer.
[AGENT][NEUTRAL] And if you have a claim number because I'm not, I don't think that was our EOB.
[AGENT][NEUTRAL] Do you have that claim number for the EOP?
[CUSTOMER][NEUTRAL] OK, it shows.
[CUSTOMER][NEUTRAL] Yes, it's 355.
[CUSTOMER][NEUTRAL] 2775.
[AGENT][NEUTRAL] OK, that is the policy number, but if you look in the EOB in the remarks section.
[CUSTOMER][NEUTRAL] the
[AGENT][NEGATIVE] It'll get the reason for the denial.
[CUSTOMER][NEUTRAL] It is one.
[AGENT][NEUTRAL] Services not covered when performed in a doctor's office. Do you see that?
[CUSTOMER][POSITIVE] OK, OK. Got it, got it.
[CUSTOMER][NEUTRAL] Yes, so.
[AGENT][NEUTRAL] That's in the remarks section.
[CUSTOMER][NEUTRAL] OK. So these services are not covered as, and is it the patient responsibility to pay the amount?
[AGENT][NEUTRAL] We're not major medical. We don't determine patient responsibility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you
[CUSTOMER][POSITIVE] Thank you so much for this information.
[AGENT][POSITIVE] It's been a pleasure to assist you with that status again. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Could you please spell out your name once?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Yes, thank you so much, [PII]. And may I know the call reference for this claim, please?
[AGENT][POSITIVE] My pleasure.
[AGENT][NEUTRAL] Call reference number is my name and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. You were very helpful today and have a great day.
[AGENT][POSITIVE] [PII], it was my pleasure to assist you with that claim status. Thank you for calling APL and I hope you have a great day as well. Take care.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye-bye.