AccountId: 011433970860
ContactId: 20336b58-f349-4c35-806b-849357d4803c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 331059 ms
Total Talk Time (AGENT): 81127 ms
Total Talk Time (CUSTOMER): 95710 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/20336b58-f349-4c35-806b-849357d4803c_20250604T15:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Oh, hi, my name is [PII]. I'm calling from the provider's office to check on a claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status, sir. Can I please get your back number?
[CUSTOMER][NEUTRAL] Uh, sure. My callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you, sir. And then what is the member's or the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, sure. Uh, the patient member ID is 02569253 and the patient name is [PII]. Uh and the date of birth is [PII].
[AGENT][NEUTRAL] OK, let me pull up his policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then what's [PII]'s date of service and charge amount?
[CUSTOMER][NEUTRAL] Uh, sure, the data services, uh, [PII] and the bill amount is $270.95.
[AGENT][NEUTRAL] OK, and then the charges after the primary.
[AGENT][POSITIVE] Insurance paid their part.
[CUSTOMER][NEUTRAL] Oh let me check on.
[CUSTOMER][NEUTRAL] Oh let me check one second.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] After primary, the balance amount is $29.28.
[AGENT][NEUTRAL] Thank you. And then may I please have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] OK, sure. The facility name is Carolina Urology Partners.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold [PII], while I look up this claim for you and I will be right back sir.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. So I do have the claim information for you.
[AGENT][NEUTRAL] The claim number 35.
[AGENT][NEUTRAL] 999973.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim has been denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Once again, let me see.
[CUSTOMER][NEUTRAL] So can you please confirm whether only the offices are not covered or any other coinsurance or the co-pay from the primary insurance is not covered?
[AGENT][NEUTRAL] Office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, one second. Can I have the call reference number?
[AGENT][NEUTRAL] Yes, you can use um and and what were you asking for the number of what was it, sir?
[CUSTOMER][NEUTRAL] Uh, call reference number?
[AGENT][NEUTRAL] Yes, you can use my name [PII] and today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Thank you for that and I do have one more claim. Can you please help me with that, sir?
[AGENT][NEUTRAL] Yes sir, can you give me the patient's name, date of birth, and policy number, sir?
[CUSTOMER][NEUTRAL] Sure, one second.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK. Uh, one second.
[CUSTOMER][NEUTRAL] OK, that is for the same patient as well and it is also donate for the
[CUSTOMER][NEUTRAL] Offices, I think I have the information now.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for the information, [PII] and have a wonderful day.
[AGENT][POSITIVE] You have a wonderful day too today [PII]. Thank you for calling APL.
[AGENT][NEUTRAL] Bye bye, sir.
[CUSTOMER][NEUTRAL] Yeah, bye-bye.