AccountId: 011433970860
ContactId: 114ce506-ac3f-4ca6-8138-e9ee0531d9c3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 281450 ms
Total Talk Time (AGENT): 87043 ms
Total Talk Time (CUSTOMER): 135833 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/114ce506-ac3f-4ca6-8138-e9ee0531d9c3_20250113T19:42_UTC.wav
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[AGENT][NEUTRAL] This is [PII].
[CUSTOMER][NEUTRAL] Hey [PII], I've got a provider on the back line that's checking the claim status on an insurance policy. He's stating he got a denial code.
[AGENT][NEUTRAL] OK. And what's that policy number?
[CUSTOMER][NEUTRAL] It's 253-810-1 [PII].
[CUSTOMER][NEUTRAL] Um, he actually gave me her old policy number. I'm not sure if that's the one that he got the denial on, but it's 240.
[CUSTOMER][NEUTRAL] 5510
[CUSTOMER][POSITIVE] And he does have the correct updated policy number now as well.
[AGENT][NEUTRAL] OK. We'll figure it out. You can send him over.
[CUSTOMER][NEUTRAL] All right, and his name is [PII] and do you want the callback number?
[AGENT][NEUTRAL] Yeah, what's the callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I got it.
[CUSTOMER][NEUTRAL] And everything's been verified.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Thank you, [PII], here he goes. Have a good day.
[AGENT][POSITIVE] You too. Thanks.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. I'm calling from Optum Medical Care. Calling to know the claim status. Could you please help me out?
[AGENT][NEUTRAL] Um, yes, sir. I can assist you with client status. Um, first, could you please verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Go on
[CUSTOMER][NEUTRAL] Yeah, sure, just a moment please.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Just the patient's name, [PII].
[CUSTOMER][NEUTRAL] Is the doctor on.
[AGENT][NEUTRAL] And her date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's the date of service and bill charges on the claim you're calling about?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Total charge amount $2,748.
[AGENT][NEUTRAL] And who's the provider?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh, the facility is O Medical Care.
[AGENT][NEUTRAL] OK, I have a client
[CUSTOMER][NEUTRAL] Do you need the rendering provider?
[CUSTOMER][NEUTRAL] I
[AGENT][NEGATIVE] Well, I have a claim on file with that date of service, but the bill charges doesn't match.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah. So it sounds like the claim is, is not on file. The claim needs to be submitted. Um, do you have the correct policy number? And would you like to verify how the claim was submitted?
[CUSTOMER][NEUTRAL] Do you need the
[CUSTOMER][NEUTRAL] Yes, actually, previously, uh, the policy number is 024.
[CUSTOMER][NEUTRAL] 05510
[AGENT][NEUTRAL] Right. Yeah, that
[CUSTOMER][NEUTRAL] So the claim was submitted with this policy number.
[AGENT][NEUTRAL] OK. Well, it would need to be resubmitted with the correct policy number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Because I'm not showing it on file.
[CUSTOMER][NEUTRAL] 9653.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah, because we have also received the denial that claim or service, claim or service covered by other payer. We deny, uh, we got the response like this.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Yes, sir, the claim can be resubmitted and when you do resubmit it, make sure you send it um under the correct policy number. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] 10
[CUSTOMER][POSITIVE] OK thank you.
[CUSTOMER][NEUTRAL] OK. Could you please provide me the policy number again?
[AGENT][NEUTRAL] Um, yes, the policy number is 02538101.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 02538101.
[AGENT][NEUTRAL] Yes, sir. That's the correct policy number.
[CUSTOMER][POSITIVE] OK, um, thank you so much for this information. May I know your name, please?
[AGENT][NEUTRAL] Yes, my name is [PII]. It's spelled [PII] and my last initial is [PII]. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] May I know the call reference for this claim, please?
[AGENT][NEUTRAL] It will be my name and today's date.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, thank you so much, [PII]. You were really helpful today and have a great day.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL um bye.
[CUSTOMER][NEUTRAL] Bye bye.