AccountId: 011433970860
ContactId: 28526b46-cdf0-42fd-8599-1a58d1146846
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 450070 ms
Total Talk Time (AGENT): 197542 ms
Total Talk Time (CUSTOMER): 302694 ms
Interruptions: 33
Overall Sentiment: AGENT=1.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/28526b46-cdf0-42fd-8599-1a58d1146846_20250108T13:55_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi [PII]. This is [PII] calling from provider's office to check up on the claim status of the patient. Could you please help me with that?
[AGENT][POSITIVE] It would be my pleasure. Do you mind spelling your name for documentation?
[CUSTOMER][NEUTRAL] It's [PII], and my initial was which is [PII].
[CUSTOMER][NEUTRAL] Could you please spell your name for me?
[AGENT][NEUTRAL] It's [PII]. And then, what is a good callback?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm. First initial last name [PII] What is a good callback number please, sir?
[CUSTOMER][NEUTRAL] [PII], OK, it's, it's [PII].
[AGENT][POSITIVE] Thank you, [PII].
[CUSTOMER][POSITIVE] Thank you, [PII].
[AGENT][POSITIVE] And it would be my pleasure to assist you with claim status today. Do you have the policy number or claim number?
[CUSTOMER][POSITIVE] And it would be my pleasure to assist you with claim status. Do you have the policy number? Yes, I do have the claim policy number here.
[CUSTOMER][NEUTRAL] Policy number here. The policy number was 124.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 193
[CUSTOMER][NEUTRAL] 2 M as Mike L as Lima 8.
[AGENT][NEUTRAL] Thank you. And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Thank you. And what is the patient's name and date of birth, please? It's [PII].
[CUSTOMER][NEUTRAL] And the date of birth was [PII].
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] Alright thank you.
[AGENT][POSITIVE] And it would be a pleasure to assist you with that claim status, Made. What is the date of service?
[CUSTOMER][NEUTRAL] And it would be a pleasure to assist you with that claim status. What is the data service. So the date of service was um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, if you will bear with me just one moment.
[CUSTOMER][NEUTRAL] OK, if you will bear with me just one moment. The policy that you gave me turned on 9124.
[AGENT][NEUTRAL] Menade, the policy that you gave me termed on 9124.
[AGENT][NEUTRAL] So I'm checking to see if he has coverage for that data service.
[CUSTOMER][NEUTRAL] So I'm checking to see if he has coverage for that data.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So bear with me just one moment.
[CUSTOMER][POSITIVE] Yeah, sure, take your time, no problem.
[AGENT][NEUTRAL] And if he does have a policy active for that data service. Can I give you the correct policy number?
[CUSTOMER][NEUTRAL] And if he does have a policy active for that data service, can I give you the correct policy number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] As of 9124, the correct policy number is 251.
[CUSTOMER][NEUTRAL] As of 9124, the correct policy number is 251.
[CUSTOMER][NEUTRAL] The service date was [PII].
[AGENT][NEUTRAL] Right, and so that policy that you gave me turned on 9124.
[CUSTOMER][NEUTRAL] Right, and so that policy that you gave me turned on 9124. 91. OK.
[AGENT][NEUTRAL] And then he does have a policy that was active for that data service.
[CUSTOMER][NEUTRAL] And then he does have a policy that was active for that date of service. OK.
[AGENT][NEUTRAL] And as of 9124, his policy number was 251.
[CUSTOMER][NEUTRAL] What was the policy number 9124. His policy number was 251251.
[AGENT][NEUTRAL] 4339.
[CUSTOMER][NEUTRAL] 4339433.
[CUSTOMER][NEUTRAL] 920 to 3 and 9 right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] That is
[AGENT][NEUTRAL] 251-433-9
[CUSTOMER][NEUTRAL] 251-433-9
[AGENT][NEUTRAL] And I do have a claim for that data service on this policy. Can you give me the bill amount and the facility name?
[CUSTOMER][NEUTRAL] And I do have a claim for that data service on this policy. Can you give me the bill amount and the facility name? Uh, the bill amount was $459 and the facility name was Holy Cross Medical Group.
[AGENT][NEUTRAL] All right, thank you. A [PII], we did receive that claim on [PII].
[CUSTOMER][NEUTRAL] Alright, thank you. And then I did receive that claim on 125-2024.
[AGENT][NEUTRAL] The claim was processed on [PII].
[CUSTOMER][NEUTRAL] OK. The payment was processed on 129-2024.19.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this claim was denied as office visits are not covered per the policy guidelines.
[CUSTOMER][NEUTRAL] And this claim was denied as office visits are not covered for the policy guidelines. Office visits not covered for the guidelines as per patients plan, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh
[AGENT][NEUTRAL] Would you like that claim number?
[CUSTOMER][NEUTRAL] Would you like that same number? Yes, please.
[AGENT][NEUTRAL] Claim number is 353.
[CUSTOMER][NEUTRAL] Claim number is 353.
[CUSTOMER][NEUTRAL] OK. 598. OK, could you please fax us the dinner I prefer this.
[AGENT][NEUTRAL] 859 8.
[AGENT][NEUTRAL] The EOBs are obtainable from our provider portal at secured that's SEC.
[CUSTOMER][NEUTRAL] The EOBs are obtainable from our provider portal at secured that's SEC.
[AGENT][NEUTRAL] You are E D as in Delta.
[CUSTOMER][NEUTRAL] You are E D as [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. [PII]. Uh, we don't have the access for the portal, so we are, uh, requesting you the EOB for this. Could you please access for it.
[AGENT][NEUTRAL] Yes, sir, if you don't mind holding just one moment, let me get that.
[CUSTOMER][NEUTRAL] Yes sir, if you don't mind holding just one moment, let me get that ready and then I'll get that fax number. Yeah, sure.
[AGENT][NEUTRAL] You'll be ready and then I'll get the fax number.
[AGENT][NEUTRAL] And if y'all can get access to that portal you'll have 24/7 access to claim status, EOBs, and you can also submit claims online as well.
[CUSTOMER][NEUTRAL] And if y'all can get access to that portal you'll have 24/7 access to claim status, EOBs, and you can also submit claims online as well. Yeah, sure.
[AGENT][NEUTRAL] Give me just one moment, I'll be right back with you to get that um fax number. And can I put this to your attention?
[CUSTOMER][NEUTRAL] Give me just one moment I'll be right back with you to get that um fax number and can I put this to your extension? Uh yes, it's Monday.
[AGENT][NEUTRAL] All right thank you one moment please.
[CUSTOMER][POSITIVE] Alright thank you one moment please.
[AGENT][NEUTRAL] [PII], I'm ready for that fax number. What is that?
[CUSTOMER][NEUTRAL] And I'm ready for that fax number. What is that? It's uh [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And just to verify that fax number?
[CUSTOMER][NEUTRAL] You wanna repeat it again? Yes it is.
[AGENT][NEUTRAL] I'm sending it to [PII].
[AGENT][NEUTRAL] [PII], is that correct?
[AGENT][NEUTRAL] Alright [PII], I just hit send you should be receiving that EOB shortly.
[CUSTOMER][NEUTRAL] Alright, I just hit send you should be receiving that EOB shortly. Yes, uh, uh, when we should, when we should receive the EOB?
[AGENT][NEUTRAL] I just hit send so it is on the way.
[CUSTOMER][NEUTRAL] I just get in, so it is on the way. OK, OK, could you please give us a call reference number for it?
[AGENT][NEUTRAL] Call reference number is my name and today's date.
[CUSTOMER][NEUTRAL] Call reference number is my name and today's date. OK.
[AGENT][POSITIVE] And it's been a pleasure to assist you with that claim status. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] It's been a pleasure to assist you with that status. Is there anything else I can help you with today? No, thank you, [PII]. Thank you for assisting me.
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a wonderful day and Me and thank you for calling APL.
[CUSTOMER][POSITIVE] And thank you for calling APL. I hope you have a wonderful day and amenity and thank you for calling APL. Thank you, bye bye.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.