AccountId: 011433970860
ContactId: 37fdf5d4-4fd8-4e2f-8a83-8e6b5e98dd73
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 407119 ms
Total Talk Time (AGENT): 86311 ms
Total Talk Time (CUSTOMER): 173822 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/01/37fdf5d4-4fd8-4e2f-8a83-8e6b5e98dd73_20250501T21:21_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you for calling APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Hi, daddy. I, well, and my name is [PII].
[AGENT][NEUTRAL] Hi [PII].
[AGENT][POSITIVE] How can I help you today?
[CUSTOMER][NEUTRAL] I'm looking for the claim status general claim status. Can you assist me?
[AGENT][NEUTRAL] Yes, I can. What is your callback number, sir, just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Yeah, OK. OK, it's my callback number is [PII].
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] Thank you. And then um what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK. First, its policy number is 02474464 M as in Mike L as in Lima number 8. And the date of birth is [PII]. Name is uh
[CUSTOMER][NEUTRAL] Get married and her son.
[CUSTOMER][NEUTRAL] And the date of service is uh [PII] of.
[CUSTOMER][NEUTRAL] [PII] and the total bill amount, just a second. Total bill amount is $570 even.
[AGENT][NEUTRAL] OK. All right, let me pull up that policy real quick.
[AGENT][NEUTRAL] OK. And then what is the charge?
[CUSTOMER][NEUTRAL] Under the provider you have, yes, OK.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] What is the charge charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, OK, it's only $60 even after primary payment.
[AGENT][NEUTRAL] OK, and then what was the name of the facility, sir?
[CUSTOMER][NEUTRAL] It's Miami Association in Pediatric Surgery.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold Ollie, while I look up this claim for us and I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me. I do have the claim information for you. The claim number is 358.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][POSITIVE] OK, 358. Good.
[AGENT][NEUTRAL] 4292.
[AGENT][NEUTRAL] And the claim has been denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] It's rich or uh totally not uh covered.
[AGENT][NEGATIVE] It's totally not covered.
[CUSTOMER][NEUTRAL] It's totally not covered. Of visit are not covered. OK, just a moment. I note it here.
[CUSTOMER][NEGATIVE] I uh visit is not colored.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Patient plan, OK.
[CUSTOMER][NEUTRAL] You.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you, uh, can any other information about the claim?
[AGENT][NEGATIVE] No, that's the only information I have is, is, it's denied because the office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Any other thing uh anyization or anything else required for this, uh, one for.
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] For this game?
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] OK, give me, uh what's your name? Sorry?
[AGENT][NEUTRAL] My, my name is [PII]. It's [PII]
[CUSTOMER][NEUTRAL] OK, uh, yes, the [PII].
[CUSTOMER][NEUTRAL] OK 30.
[CUSTOMER][NEUTRAL] OK, and I check if any of the claim on the same.
[CUSTOMER][NEUTRAL] To what do you and you and then I said to you American Public life insurance.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, no claim on your end, uh, it's not this. Give me the call reference number.
[AGENT][NEUTRAL] Yes sir, you can use my name and today's date.
[CUSTOMER][POSITIVE] Today's date. OK. Thank you. Have a nice day.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] You're very welcome, Ollie. You have a wonderful night and that's everything I can help you with.
[CUSTOMER][POSITIVE] I can uh, thanks for your study.
[AGENT][POSITIVE] You're welcome. You, you too, and thank you for calling APL. Bye bye.
[CUSTOMER][POSITIVE] Have a nice day.
[CUSTOMER][NEUTRAL] Bye for now.