AccountId: 011433970860
ContactId: 042567fb-baaf-473c-a7d4-7bc5abac3a3d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 362000 ms
Total Talk Time (AGENT): 110136 ms
Total Talk Time (CUSTOMER): 143320 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/042567fb-baaf-473c-a7d4-7bc5abac3a3d_20250204T17:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling BCL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Hi, this is [PII] from provider's office. I want to know the claim status.
[AGENT][POSITIVE] OK, [PII], I'm happy to check on a claim for you today. What is the patient's policy number?
[CUSTOMER][NEUTRAL] Mm, yes, once again.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes. So the member's policy number is 02185075 M as in Mike L as in Lima, 8.
[AGENT][POSITIVE] All right, thank you for that, [PII], and then.
[AGENT][NEUTRAL] What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Patient name is [PII] and date of birth, [PII].
[AGENT][POSITIVE] Thank you for that and date of service?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] You're asking for data service, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So, the date of service is [PII], [PII].
[AGENT][NEUTRAL] [PII]. Thank you. And the bill amount?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] $1,306 even 1306.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Hey.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hello, [PII], are you there?
[AGENT][NEUTRAL] Yes, [PII], thank you for your patience on that. So it looks like we did receive the claim, uh, let me give you the received date. Claim is received [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] The claim was denied, office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry, could you repeat? Your voice suddenly broke.
[AGENT][NEUTRAL] I'm sorry, what was that again?
[CUSTOMER][NEGATIVE] Your voice suddenly broke. I couldn't um
[CUSTOMER][NEUTRAL] Here you what you said, the denial was.
[AGENT][NEUTRAL] Oh, office visits are not covered under the member's policy.
[CUSTOMER][NEGATIVE] That are not good.
[CUSTOMER][NEUTRAL] Member's policy, OK. May I know the name of the policy?
[AGENT][NEUTRAL] We are the secondary medin plan.
[CUSTOMER][NEUTRAL] The secondary Malin, M E D L I N G?
[AGENT][NEUTRAL] L I N K, K as in kilo at the end.
[CUSTOMER][NEUTRAL] MED Alliance, OK, Metallink plan. So visits are not covered under this. Can you bill it to patient?
[AGENT][NEUTRAL] We're not able to advise on patient responsibility that's up to the facility or provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get the appeal mail address?
[AGENT][NEUTRAL] That would be [PII].
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's in [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Can I know the family clothing from thee?
[AGENT][NEUTRAL] Appeals must be filed within 180 days of the decision.
[CUSTOMER][NEUTRAL] May I know the date of the or date of the month?
[AGENT][NEUTRAL] Clame was denied [PII].
[CUSTOMER][NEUTRAL] 2nd [PII]. OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] May I know the claim number?
[AGENT][NEUTRAL] Claim number is 353-377-0.
[CUSTOMER][NEUTRAL] 353-377-0. Am I right?
[AGENT][POSITIVE] That is, that is correct. Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get the call reference number?
[AGENT][NEUTRAL] Call references my name with my last initial than today's date. My name again is [PII], that's [PII] Last initial to my name is [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] You're welcome, [PII]. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Have a
[CUSTOMER][NEUTRAL] That's it for today.
[AGENT][POSITIVE] All right. Have a good day.
[CUSTOMER][POSITIVE] OK. Have a good day. Bye.