AccountId: 011433970860
ContactId: 224a83ba-c8fc-4e20-ab8c-c33a1cd74b82
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 706289 ms
Total Talk Time (AGENT): 148598 ms
Total Talk Time (CUSTOMER): 82686 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=-1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/224a83ba-c8fc-4e20-ab8c-c33a1cd74b82_20250122T21:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII], and I'm calling from Centai Medical Group. I was trying to check on the status of a claim, please.
[AGENT][NEUTRAL] OK, and what was the name of the middle group you're calling for again?
[CUSTOMER][NEUTRAL] Centerra
[AGENT][NEUTRAL] OK, Miss [PII], I can look at um a claim for you.
[AGENT][NEUTRAL] And then what is your call back number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and what is the patient's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and then [PII]'s policy number please.
[CUSTOMER][NEUTRAL] 02440115
[AGENT][NEUTRAL] OK, let me look that up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK thank you and then what is the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the charge amount please.
[CUSTOMER][NEUTRAL] $290.
[AGENT][NEUTRAL] OK, and then what is the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, we were looking for a payment of $102.90.
[AGENT][NEUTRAL] Thank you. OK, Miss [PII], I'm gonna put you on a brief hold while I pull in the claim for you and I'll be right back.
[CUSTOMER][POSITIVE] All right thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hi, Miss [PII]. This is [PII]
[AGENT][POSITIVE] Up for you
[AGENT][NEUTRAL] The claim number is 353-6174.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you repeat that? The call was kind of breaking up.
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] I'm so sorry about that. It's 35.
[AGENT][NEUTRAL] 36
[AGENT][NEUTRAL] 174.
[CUSTOMER][NEUTRAL] Did you say 174?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] All right, OK.
[AGENT][NEUTRAL] And then the claim was denied. Um, there's 3 reasons, the office visits are not covered under the policy.
[AGENT][NEUTRAL] Uh, the next reason is the benefits are payable only if the major medical insurance provider provides the benefits.
[AGENT][NEUTRAL] If it's later paid by the major medical insurance, please send an explanation of benefits showing the benefits were paid.
[AGENT][NEUTRAL] And then the last one is insurance primary insurance provided benefits there are no benefits payable.
[AGENT][NEUTRAL] And that was on, let's see.
[AGENT][NEUTRAL] That was the 3.
[AGENT][NEUTRAL] Remarks for the 3 different procedure codes.
[CUSTOMER][NEUTRAL] Alright, and when was this done on?
[AGENT][NEUTRAL] It was received.
[AGENT][NEUTRAL] On
[AGENT][NEUTRAL] [PII] and it was processed also on [PII].
[CUSTOMER][NEUTRAL] [PII], is there any way you could fax that EOB to me?
[AGENT][POSITIVE] Yes ma'am, I can fax that to you. What is your fax number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I'm gonna put you on hold while I get that fax ready for you and I'll be right back.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on, my goodness.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] I know, this thing's taking forever.
[AGENT][POSITIVE] Hi Miss [PII], this is [PII] thank you very much for waiting. My computer was being a little slow um but I do have that fax on its way to you.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, OK, great, thank you. Well [PII], do you have a reference number for our call today?
[AGENT][POSITIVE] Yes ma'am you can use my name and today's date.
[CUSTOMER][POSITIVE] Right, I appreciate your time and help thank you.
[AGENT][POSITIVE] You're very welcome. You have a blessed rest of your week and thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][NEUTRAL] Mhm. Bye-bye, ma'am.