AccountId: 011433970860
ContactId: 2c49be74-5179-4d43-878d-d9bdac855914
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 398760 ms
Total Talk Time (AGENT): 154457 ms
Total Talk Time (CUSTOMER): 181745 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/2c49be74-5179-4d43-878d-d9bdac855914_20250220T16:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning. I'm calling to check on a claim please.
[AGENT][POSITIVE] All right. I'm happy to check on a claim today. What's the patient's policy number?
[CUSTOMER][NEUTRAL] It is 01417753 M as in Mary, L as in Lima 8 as in the number 8.
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] And if you don't mind, can I grab your first name?
[CUSTOMER][NEUTRAL] Sure, my name is [PII]. It's spelled [PII]
[AGENT][NEUTRAL] Thank you [PII] and then patient name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is under [PII]. Birth date is [PII].
[AGENT][POSITIVE] Thank you and then data service.
[CUSTOMER][NEUTRAL] I have a couple for him. The first one is [PII]. Let me look at the bill amount here, $661.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me take a look here and see what we got.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so looks like on this one, I mean we did get a claim, um, it looks like it was denied office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Let me look and see what we have here.
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] OK, OK, so we do have other insurance, so I'll just bill him after that. Can you tell me the claim number, please?
[AGENT][NEUTRAL] Absolutely claim number on this is 3533907.
[CUSTOMER][NEUTRAL] OK, great, and then I do have another one for him same patient different data service if we can look at another one.
[AGENT][POSITIVE] Yeah, absolutely. What's her date?
[CUSTOMER][NEGATIVE] It is [PII] billed amount of $269 and I bet it's the same denial.
[AGENT][NEUTRAL] All right, let's see.
[CUSTOMER][NEUTRAL] It's an office visit.
[AGENT][NEUTRAL] Yeah, it looks like same denial. Do you need the uh claim number?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, claim number on this one is going to be 354-922-9.
[CUSTOMER][NEUTRAL] Got it. OK. And then let's see, let's look at another one. I have [PII] for 381, but it's also an office visit.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, I was looking, so while you're looking, I was looking on the portal and they aren't coming up, so I don't know if I enter all the information it says no claims on file. I'm like, hmm, because I did enter it on the portal, you know, just with so I'm not sure why that's not coming up.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah, that's strange. I haven't, I wonder if there's been.
[AGENT][NEUTRAL] Anybody reporting anything, having issues.
[AGENT][NEUTRAL] Um, this one, I mean, it looks like we did get this one for 111 of 24. It was the same denial. I can give you this claim number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Claim number on this is 353-3906.
[CUSTOMER][POSITIVE] OK, great. All right, let's look at another one. Let's see that one.
[CUSTOMER][NEUTRAL] 111 I already did so 114 for 821 $821.20. I know this one isn't an office.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so we did get this claim for 114-24. Looks like denial showing services not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] So the place of service is different, hm OK well let me look into that. Let me get that claim number.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Claim number on this one is going to be 354-923-3.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, great, thank you and I have one more if you have time for one more, let's see, actually two more so sorry so the next one is the [PII] uh sorry, [PII] for 269.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yeah. No problem.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] 269.
[CUSTOMER][NEUTRAL] And I believe this one's an office visit too.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] Yeah, this is an office visit so this claim number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, claim number on this is 354-9268.
[CUSTOMER][NEUTRAL] Got it. OK. And then one more, it is an office visit if I can just get a claim number, a denied claim number.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It is for [PII], 269 also.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, that claim number is going to be 355.
[AGENT][NEUTRAL] 883 5.
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][NEUTRAL] All right, let me get a reference number for a call and I'll look into that denied one and we'll go from there.
[AGENT][NEUTRAL] Absolutely call references my name with my last initial then today's date. My name is [PII], which is [PII] and my last initial is [PII].
[CUSTOMER][POSITIVE] Got it alright thank you so much for your time today.
[AGENT][POSITIVE] You're welcome. Have a good one.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][NEUTRAL] Bye bye.