AccountId: 011433970860
ContactId: 205b3be9-83d4-46c9-9e3b-b19b47f700df
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 618880 ms
Total Talk Time (AGENT): 230640 ms
Total Talk Time (CUSTOMER): 192376 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/205b3be9-83d4-46c9-9e3b-b19b47f700df_20250228T14:41_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling you from the provider's office to check the status for this number.
[AGENT][POSITIVE] It would be my pleasure to assist you. And what was your name?
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] Can you spell that just for um documentation?
[CUSTOMER][NEUTRAL] Yeah. It's [PII].
[AGENT][POSITIVE] Thank you, [PII], and what is a good callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the patient's policy number?
[CUSTOMER][NEUTRAL] The patient's policy number is 1407207M as in L as in Lion and 8.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the last name is, middle name is uh [PII], and the last name is [PII]. And the date of birth is [PII].
[AGENT][NEUTRAL] All right, thank you, and you're needing claim status for [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, I can help you with that claim status. [PII], what is the data service?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] And the bill out, please.
[CUSTOMER][NEUTRAL] $1,124 even.
[AGENT][NEUTRAL] And what is the facility name please ma'am, or please?
[CUSTOMER][NEUTRAL] The facility name is Gastro Health LLC.
[AGENT][NEUTRAL] All right, thank you. I can help you with that claim status. Let me get that received date, bear with me one moment.
[AGENT][NEUTRAL] That claim we received on [PII] and processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now the claim was denied.
[AGENT][NEUTRAL] As the outpatient benefits for the calendar year has been met.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Yeah, can you, can you just give me a second?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, did you say it was received on [PII]?
[AGENT][NEUTRAL] [PII]. I'm sorry, [PII].
[CUSTOMER][NEUTRAL] Maybe.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], I'm sorry, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And processed on the same day.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, and it was denied?
[AGENT][NEGATIVE] Denied as the maximum benefit.
[CUSTOMER][NEUTRAL] Did.
[AGENT][NEUTRAL] For the calendar year.
[AGENT][NEUTRAL] Has been met.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] It's.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And denied on [PII].
[AGENT][NEUTRAL] [PII], same date that we received it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's on, on [PII], uh, from our side, it, it was requested for the check traer, right?
[AGENT][NEUTRAL] Can you repeat that?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] On [PII] from our side, it was requested for the check traces.
[AGENT][NEUTRAL] The check
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a second, let me check on that for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] Alright, let me get this to our claims department. Do you mind holding back?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] Can I, can I provide the call reference number so you can track the information?
[AGENT][NEUTRAL] Yes, my name is you want my name?
[AGENT][NEUTRAL] The call reference number is my name and today's date and I'm gonna get you to an example.
[CUSTOMER][NEUTRAL] Can you please spell your name?
[AGENT][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] And if you don't mind holding just one moment I'll get another representative who can assist you further, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Ferring.
[CUSTOMER][NEUTRAL] This [PII].
[AGENT][POSITIVE] Hey, happy Friday.
[CUSTOMER][POSITIVE] Happy Friday, how are you?
[AGENT][POSITIVE] I'm doing well. How about yourself? It's been so long since I've heard your sweet voice.
[CUSTOMER][NEUTRAL] I know, right?
[AGENT][POSITIVE] I've been good.
[CUSTOMER][POSITIVE] Yay.
[AGENT][NEGATIVE] It's hard.
[CUSTOMER][POSITIVE] Yay, I'm so proud of you. I knew you could do it.
[AGENT][NEUTRAL] I know, I know, I know, I know I can do too, but sometimes we need a little help and a little research by somebody that.
[CUSTOMER][POSITIVE] Well, just call me. I'm here for you.
[AGENT][NEUTRAL] Well, I've got a provider and this is gonna need a little research.
[CUSTOMER][NEUTRAL] Oh God.
[AGENT][NEUTRAL] I'm so sorry. It's um.
[CUSTOMER][NEUTRAL] Tell them to call us back in June.
[AGENT][POSITIVE] I do, I love it. Can't wait till after my birthday, let's just say [PII].
[CUSTOMER][POSITIVE] Yeah. There you go, that's even better.
[AGENT][POSITIVE] I just adore you. The policy number is 140.
[AGENT][NEUTRAL] 7207 Rosemary Paulina Jurado.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Very good. Come on, so slow.
[AGENT][NEUTRAL] I speak Spanish.
[CUSTOMER][POSITIVE] I know I heard you speaking very well. OK, I got it.
[AGENT][NEUTRAL] Uh, I don't know that very well, but, you know, yeah.
[CUSTOMER][POSITIVE] Yes, you do.
[AGENT][NEUTRAL] I've got [PII] on the line, B E C K.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Call back [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Calling for claim status, I gave him claim status on claim number 353.
[AGENT][NEUTRAL] 358 4.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But then he states that it would that the payment was supposed to have been reissued looks like I I'm not sure sometimes the notes don't.
[AGENT][NEUTRAL] Flow to me, um, claim number 3,495,580 was voided, but then.
[AGENT][NEUTRAL] I don't know if it's supposed to be reissued under this new claim number or uh.
[AGENT][NEUTRAL] Can you research that and help back a little further?
[CUSTOMER][NEUTRAL] Who knows.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes, I will. Thank you.
[AGENT][NEUTRAL] This one made me feel like [PII] for a moment. What, what, what.
[CUSTOMER][NEUTRAL] Huh?
[AGENT][NEUTRAL] It's spinning
[CUSTOMER][NEGATIVE] Please don't.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I hear you.
[CUSTOMER][POSITIVE] I got you I got you.
[AGENT][POSITIVE] All right, I, I appreciate it, [PII]. Let me get back on the line. Hope you have a great weekend.
[CUSTOMER][POSITIVE] You as well. Thank you.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] [PII], thank you for your patience. I have [PII] on the line and she is researching that further and will assist you further, and I did explain.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] For the claim status, thank you for calling APR have a wonderful week.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And can you please provide?
[CUSTOMER][NEUTRAL] Money, hi, this is [PII]. How are you today?
[CUSTOMER][POSITIVE] I'm doing good. What about you? I am great, thanks for asking, and I'll be happy to assist you with the claim status. It looks like data service 8-172023.
[CUSTOMER][NEUTRAL] Gastro Health, so.
[CUSTOMER][NEUTRAL] It's processed under 3,495,580.
[CUSTOMER][NEUTRAL] And then it looks like it's reprocessed.
[CUSTOMER][NEUTRAL] And let me go back up here.
[CUSTOMER][NEUTRAL] Looks like it's reproceed. I wanna make.