AccountId: 011433970860
ContactId: 224567f0-52ba-41fe-be35-c5547ef35eae
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 384799 ms
Total Talk Time (AGENT): 110134 ms
Total Talk Time (CUSTOMER): 139348 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/224567f0-52ba-41fe-be35-c5547ef35eae_20250306T22:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hey, hi, I'm [PII] calling from office to check on the claims.
[AGENT][NEUTRAL] I'm sure, [PII] I can assist you with claim status. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Sure, that's [PII]. That's a direct line.
[AGENT][NEUTRAL] OK. Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] Policy number is gonna be 017.
[CUSTOMER][NEUTRAL] 405
[CUSTOMER][NEUTRAL] 05 M. Mike L. Lima 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. Now I need the date of service and bill charges on the claim, please.
[CUSTOMER][NEUTRAL] Day of service is gonna be [PII] and build on $638 even.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Please repeat the bill charges.
[CUSTOMER][NEUTRAL] $638 even.
[AGENT][NEUTRAL] OK, thanks for your patience. Yes, we received that claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim number is 356.
[AGENT][NEUTRAL] 984 8.
[AGENT][NEUTRAL] And the claim denied for the place of service, um, services provided in the doctor's office is not covered under this policy.
[CUSTOMER][NEUTRAL] OK, just a moment tonight uh.
[CUSTOMER][NEUTRAL] OK, so so.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, doctors, uh, the treatment rendered on the office, uh, doctor's office, the client will be denied as uncovered, right under this patient's plan, right?
[AGENT][POSITIVE] That's correct.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] So, uh, just a moment.
[CUSTOMER][NEUTRAL] And this claim as a place for service of 11 which is office visit, OK and uh if you submit to collected claim with uh
[CUSTOMER][NEUTRAL] I mean, uh, if we use any other type of service, then it's possibility to, uh, get the payment, and may I know the places covered place of services for these patients, patients plan.
[AGENT][NEUTRAL] Yes, and just let me advise you the verification of coverage. It does not guarantee payment of claims. Um, the covered places of service is inpatient hospital and outpatient hospital.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And MRI facilities.
[CUSTOMER][NEUTRAL] Inpatient, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So the place of service 21 and 22, right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Patient
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, uh, outpatient inpatient services, right? Inpatient services and outpatient services.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, this of service 21.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So can you send me the character claim uh for this one?
[AGENT][NEUTRAL] Yes, you can submit a correct claim. Yes, sir.
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, can I have the mailing address and the payer ID to somebody about that thing.
[AGENT][NEUTRAL] Yes, the payer ID is 60801.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the mailing address is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So start
[CUSTOMER][NEUTRAL] Uh, American, uh, start with American.
[CUSTOMER][NEUTRAL] Public life, right?
[AGENT][NEUTRAL] Um
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You could you spell your name for me?
[AGENT][NEUTRAL] Um, it's [PII]. It's spelled [PII] and my last initial is [PII]. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Uh, no, uh
[CUSTOMER][NEUTRAL] Actually, I can't get your name. Could you spell it out for me because uh [PII]?
[AGENT][POSITIVE] Yes, that's, yes, that's correct.
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I have a reference number.
[AGENT][NEUTRAL] The reference number is my name and today's date.
[CUSTOMER][POSITIVE] OK, thanks for the information. Have a nice day bye.
[AGENT][POSITIVE] OK. Thank you, [PII], for calling APL. You have a great day as well. Mm bye.
[CUSTOMER][NEUTRAL] Mm bye bye.