AccountId: 011433970860
ContactId: 063e7ace-1e1a-4258-ac48-43a517ad1593
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 851919 ms
Total Talk Time (AGENT): 129752 ms
Total Talk Time (CUSTOMER): 115253 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=-1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/063e7ace-1e1a-4258-ac48-43a517ad1593_20250321T16:20_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from office, and I'm just checking on a claim status of a patient.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status, Mr. [PII] and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you. And may I have um the patient's policy number?
[CUSTOMER][NEUTRAL] Patient policy number is gonna be 025457440.
[AGENT][NEUTRAL] OK, and may I have the name of the facility you're calling from, Mr. [PII]?
[CUSTOMER][NEUTRAL] It's still my DPMP.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Full name is gonna be [PII] Hart was [PII].
[AGENT][NEUTRAL] I'm sorry, can you repeat that information?
[CUSTOMER][NEUTRAL] First name is [PII]. Last name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] There is also I'm checking on [PII].
[CUSTOMER][NEUTRAL] Total charge amount would be $110 even.
[AGENT][NEUTRAL] OK, thank you. Let me see if I can find this claim, and that was [PII] or [PII], correct?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Sure. Take your time.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, looks like we received the claim on [PII], and we processed [PII].
[AGENT][NEUTRAL] And the claim was denied. The reason for this denial is that office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] So it was denied on [PII], right?
[AGENT][NEUTRAL] [PII], correct.
[CUSTOMER][NEUTRAL] OK, it's sitting there non-covered because they build a procedure, uh, outpatient offices that is not covered under the patient policy.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. May I have the patient policy name but it is not covered?
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical.
[AGENT][NEUTRAL] And it's not a cover service on the patient's plan.
[CUSTOMER][NEUTRAL] Uh, can you repeat that plane name again?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Plant name again, please?
[CUSTOMER][NEUTRAL] Can I get the plan name again? Sorry, I.
[AGENT][NEUTRAL] This is a secondary.
[AGENT][NEUTRAL] This this is a secondary supplemental plan.
[CUSTOMER][NEUTRAL] OK. Under this plan, uh, this, it is not covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, can we build the patient for the service then?
[AGENT][NEUTRAL] It's up to the provider's discretion. We don't have any contractual involvement on the remaining of the claim.
[CUSTOMER][NEUTRAL] You know what
[CUSTOMER][NEUTRAL] OK then I understand.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, then. I understand. Got it. Uh, may I have the spelling of name, please?
[AGENT][NEUTRAL] Sure, that's [PII]. Last initial is [PII].
[CUSTOMER][NEUTRAL] Got it. So, so, uh, OK, our patients is not covered on the patient plan. Patient plan name is secondary supplemental plan. And can I have the contact number, please?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] Do you have the claim number? I can I have the claim number so in case the the important thing.
[AGENT][NEUTRAL] Mhm. Sure. Yes, that's 356-434-4.
[CUSTOMER][NEUTRAL] 356-434-4 right? By any chance do you have the UOB with you?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] Uh, uh, yes, please, so would be able to be fax it to me.
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, to your attention, Mr. [PII].
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][NEUTRAL] OK thank you one moment.
[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] Uh, yes, so.
[AGENT][NEUTRAL] You know.
[AGENT][NEUTRAL] Hello? Yes.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Can you hear me?
[AGENT][NEUTRAL] Mr. [PII], I cannot hear you. Hello?
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Mr. [PII], I cannot hear you.
[AGENT][NEUTRAL] Mr. [PII], hello.
[AGENT][NEUTRAL] Hello, Mr. [PII], can you hear me?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, can you hear me?
[AGENT][NEUTRAL] Mr. [PII], can you hear me?
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.