AccountId: 011433970860
ContactId: 056e8eec-da2c-4045-bc2a-f461ec99d14a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 411890 ms
Total Talk Time (AGENT): 125572 ms
Total Talk Time (CUSTOMER): 89173 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/056e8eec-da2c-4045-bc2a-f461ec99d14a_20250616T21:04_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider office. And before that, this call is being recorded for quality and training purpose. Is it OK for you?
[AGENT][POSITIVE] Sure, yes, um, I can assist you. May I have the spelling of your name?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, can you repeat that one more time?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 01912979
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] And also, can you spell your name?
[AGENT][NEUTRAL] Sure. My name is [PII].
[CUSTOMER][NEUTRAL] OK. So thanks, and this call is being recorded. Is it OK for you, [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][NEUTRAL] And what's the name and date of birth of the patient, Mr. [PII]?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, and
[AGENT][NEUTRAL] What information are you needing today? Is it claim status or um but if it's claims, OK. What's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Claims. Yes, claims.
[CUSTOMER][NEUTRAL] [PII] bill amount $398 even.
[AGENT][NEUTRAL] [PII] for 398?
[CUSTOMER][NEUTRAL] Yeah, [PII], 398.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Alright, let me pull this ELB one moment.
[AGENT][NEUTRAL] OK, I'm still waiting on the AOB be me.
[AGENT][NEUTRAL] OK, let's see. Looks like it was processed on [PII] and the claim was denied. The reason for this denial is that
[AGENT][NEUTRAL] That this is not a cover loss under the benefit plan.
[CUSTOMER][NEUTRAL] Sorry, I didn't get. Can you repeat me the reason?
[AGENT][NEUTRAL] OK, this is not a covered loss under the plan.
[CUSTOMER][NEUTRAL] OK, but it's an office visit, uh, outpatient office visit. So this service is not come under the patient's plan?
[AGENT][NEGATIVE] It's not.
[CUSTOMER][NEGATIVE] Sorry, I didn't get.
[AGENT][NEUTRAL] Office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, what is the claim number?
[AGENT][NEUTRAL] It's 349-968-3.
[CUSTOMER][NEUTRAL] OK. When did you receive the claim?
[AGENT][NEUTRAL] Let me get that for you. That's not on the AOB. One moment.
[AGENT][NEUTRAL] 83 [PII] was received [PII] was processed.
[CUSTOMER][NEUTRAL] And as you told that the claim is denied that service are not covered under the patient's plan, right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK. Can you fax me the UBN? I want to, is this a limited benefit plan?
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] OK. Can you fax me the UB for this one?
[AGENT][NEUTRAL] Sure, what is the fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment, let me send this out to you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And that
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Waiting on the system, bear with me.
[CUSTOMER][NEUTRAL] And the whole amount is patient responsibility, right?
[AGENT][NEUTRAL] It's up to the provider's discretion. We're just a secondary.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, it should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] No, no, that's it. You can provide me the call reference number.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] So thanks for helping, assisting in the claim. Have a good day. Bye for now.
[AGENT][POSITIVE] Yes, ma'am. Thank you for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] You too.