AccountId: 011433970860
ContactId: 371d964e-12fe-4a6b-bf62-cbdba57601f9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 233039 ms
Total Talk Time (AGENT): 69149 ms
Total Talk Time (CUSTOMER): 79309 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.4, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/371d964e-12fe-4a6b-bf62-cbdba57601f9_20250521T17:24_UTC.wav
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[AGENT][NEUTRAL] For calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] This is [PII] calling from Bayram Healthcare Center. Can you hear me?
[AGENT][POSITIVE] Yes, I can.
[CUSTOMER][NEUTRAL] Actually, I just needed help in a claim. Will you please help me with the claim?
[AGENT][NEUTRAL] Yes, I can help you with claim status, [PII]. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, that is [PII].
[AGENT][NEUTRAL] And the policy number for the patient?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] The policy number for the patient?
[CUSTOMER][NEUTRAL] Policy number. OK. Do you want member ID number?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. That is 01792125.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Date of service and bill charges?
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] The data service is [PII].
[CUSTOMER][NEUTRAL] Sorry, [PII] and the bill amount is $2410.74.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh, claim was received on [PII].
[AGENT][NEUTRAL] Process [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEGATIVE] Uh, item does not meet the definition of durable medical equipment under policy contract.
[AGENT][NEGATIVE] Therefore, we're unable to provide benefits.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So can you tell me the current status of that claim? I it is in the process, denied or analyzed?
[AGENT][NEUTRAL] The claim was denied, and the denial remark is
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] The item does not meet the definition of durable medical equipment under the policy contract.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, what can we do from my end?
[AGENT][NEUTRAL] And let me pull up the.
[AGENT][NEUTRAL] Look up what we received. Hold on one moment.
[CUSTOMER][NEUTRAL] Because we don't have any UV of that claim. we did not get UV yet.
[AGENT][NEUTRAL] OK. Do you, do you need the EOB?
[CUSTOMER][NEUTRAL] Yeah, if you can transfer the UB via fax that can be helpful for us.
[AGENT][NEUTRAL] OK, what's the fax number?
[CUSTOMER][NEUTRAL] The tax code is [PII].
[AGENT][NEUTRAL] OK, that's [PII].
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, I'll get that faxed over and I'll have the explanation of why it was denied. Um, is there anything else I can help with today?
[CUSTOMER][NEUTRAL] No, not much. Could you please tell me your name again?
[AGENT][NEUTRAL] Uh my name is [PII]. It's [PII]
[CUSTOMER][POSITIVE] OK, [PII], thank you so much for confirming your name. That is for today. You can tell me to call Doctor.
[AGENT][NEUTRAL] A reference number is my name and today's date.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[CUSTOMER][POSITIVE] Have a great day. Bye for now.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thanks for calling APL. You too. Bye.