AccountId: 011433970860
ContactId: 0a5fcc72-aa65-42d0-84c4-b66087a58d35
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 437410 ms
Total Talk Time (AGENT): 142079 ms
Total Talk Time (CUSTOMER): 133928 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/0a5fcc72-aa65-42d0-84c4-b66087a58d35_20250423T16:27_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from the doctor's office and calling on the status of a claim.
[AGENT][POSITIVE] I'm sure I can assist you with claim status. First, I'll need to get your name again and a good callback number.
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. My last initial is [PII].
[CUSTOMER][NEUTRAL] My direct telephone number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now I need the policy number.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] This patient policy number is.
[CUSTOMER][NEUTRAL] 1275591.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Spe is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. Um, now I need the date of service and bill charges for the claim you're calling about.
[CUSTOMER][NEUTRAL] Yes, service date is [PII].
[CUSTOMER][NEUTRAL] Total charge on this claim is.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] $179 even.
[AGENT][NEUTRAL] OK. Yes, sir. We did receive that claim on.
[AGENT][NEGATIVE] We received the claim on [PII]. It was processed on [PII], and it's um denying um because office visits are not covered under this policy, and I have the claim number here.
[CUSTOMER][NEUTRAL] Go with the claim number.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] The claim number is 3581078.
[CUSTOMER][NEUTRAL] Is it, can you repeat that claim number again? 35.
[AGENT][NEUTRAL] 3581078
[CUSTOMER][NEUTRAL] When was it denied you said it?
[AGENT][NEUTRAL] Hey, was the night on.
[AGENT][NEUTRAL] It was denied on [PII].
[CUSTOMER][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] What is your city? Sure.
[AGENT][NEUTRAL] It was denied on March. Yes, it was denied on [PII].
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] This is the date is [PII] and denied on [PII].
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] As uh
[CUSTOMER][NEUTRAL] Oh so they see that are not covered under this plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Is it, is it any prior that I uh before this?
[AGENT][NEUTRAL] Um, yes, there was a denial before that one. Let me get that one.
[CUSTOMER][NEUTRAL] Yeah, we received the status of it uh.
[CUSTOMER][NEUTRAL] I have the claim number as 345.
[CUSTOMER][NEUTRAL] 6150.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Is that right?
[AGENT][NEGATIVE] One moment. You said 345-6150. Yes, we received that one on May, yeah, [PII] and it processed and denied on [PII]. And then the one I just gave you, it also denied again for the same reason. Of visits are not covered.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can I know the reason why this, uh offices are not covered under this patient card? What type of plan the patient has?
[AGENT][NEUTRAL] This is secondary gap insurance and um office visit co-pays are not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Patient
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Secondary.
[CUSTOMER][NEUTRAL] What gap you stated?
[AGENT][NEUTRAL] Gap Insurance, GAP insurance.
[AGENT][NEUTRAL] And office visits are not covered.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with, [PII]?
[CUSTOMER][NEUTRAL] Yeah, main reason we called on this claim is we have requested a copy of a UB through fax. We haven't received so far.
[CUSTOMER][NEUTRAL] Can you send a copy of the EOB?
[AGENT][NEUTRAL] Yes, what's your fax number?
[CUSTOMER][NEUTRAL] The fax number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so that's attention, [PII] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, kindly also mention this uh patient account number.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The patient account number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 56,590
[AGENT][NEUTRAL] OK, that's [PII].
[CUSTOMER][NEUTRAL] 5,654,900
[AGENT][NEUTRAL] 5,654,900.
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] Mm. OK.
[CUSTOMER][NEUTRAL] If you are faxing it when I when we will receive it.
[AGENT][NEUTRAL] You should receive it in about 10 minutes.
[CUSTOMER][POSITIVE] Oh great.
[CUSTOMER][NEUTRAL] Do you have a call reference number for this inquiry?
[AGENT][NEUTRAL] Yes, the reference number is my name and today's date. My name is [PII]. It's spelled [PII] Last initial is [PII] and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Uh, there is a break, break on the phone. Did you spell your name as [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, OK, that's all the information looking for today. Thank you. Have a nice day. Bye now.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL. bye.
[CUSTOMER][NEUTRAL] Bye.