AccountId: 011433970860
ContactId: 0b6c59cb-e098-4cf9-a86e-cd18b1299ad7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 355880 ms
Total Talk Time (AGENT): 97554 ms
Total Talk Time (CUSTOMER): 80328 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/0b6c59cb-e098-4cf9-a86e-cd18b1299ad7_20250320T14:40_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, this is [PII] calling on behalf of Forest office to check on a claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status. Can I please get your callback number, sir, just in case the call is disconnected?
[CUSTOMER][NEUTRAL] So, the callback number is [PII].
[CUSTOMER][NEUTRAL] [PII] and the extension is [PII].
[AGENT][NEUTRAL] Thank you, sir. And then can you please give me the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. The patient name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[CUSTOMER][NEUTRAL] The insured ID number is 024.
[CUSTOMER][NEUTRAL] 658.
[CUSTOMER][NEUTRAL] 89.
[AGENT][NEUTRAL] OK, let me pull up that policy real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, and can you please give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Yes, sir. The date of service is [PII].
[CUSTOMER][NEUTRAL] And the total bill amount is $218 even.
[AGENT][NEUTRAL] And that's 218.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and then can you give me the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] $40.
[AGENT][NEUTRAL] OK, and can you please give me the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Yes, sure.
[CUSTOMER][NEUTRAL] The name of the facility is Ohio Health Physicians Group.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim for us, [PII] and I'll be right back.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] You are on
[AGENT][NEUTRAL] Thank you for holding for me [PII]. I have the claim on uh pulled up now. Let me give you the claim number.
[AGENT][NEUTRAL] It's 350-7002.
[CUSTOMER][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] And the claim was denied for two reasons. One is office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the other one is that the insurance primary insurance provided full benefits. There are no benefits payable.
[CUSTOMER][NEUTRAL] OK. So, primary paid more than secondary, right?
[AGENT][NEUTRAL] Right, the primary paid.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so for this, uh, can we build the patient?
[AGENT][NEGATIVE] I cannot give patient responsibility or advise on how you should be.
[CUSTOMER][NEUTRAL] OK, sure. Thanks for providing me this information. Can I get the call reference number?
[AGENT][NEUTRAL] Yes, you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] Yes, thank you so much for providing me this information. Have a great day.
[AGENT][POSITIVE] You too thank you [PII] for calling APL. I hope you have a wonderful day also.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you bye bye.