AccountId: 011433970860
ContactId: 384e84de-3753-4a35-a9b5-89c2f196861f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 696640 ms
Total Talk Time (AGENT): 103611 ms
Total Talk Time (CUSTOMER): 132100 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=-1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/384e84de-3753-4a35-a9b5-89c2f196861f_20250314T16:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hello [PII]. This is [PII]. I'm calling in regards to a claim status.
[AGENT][NEUTRAL] OK, [PII], what is your callback number just in case our call is disconnected and I'll be able to help you with claim status.
[CUSTOMER][NEUTRAL] Yes. So, for my callback number, that will be [PII]. That is a direct line.
[AGENT][POSITIVE] Thank you so much. And then what is the patient's name, date of birth?
[AGENT][NEUTRAL] And policy number?
[CUSTOMER][NEUTRAL] So, for the policy number that is 02292691.
[CUSTOMER][NEUTRAL] First and last name of the member will be [PII].
[CUSTOMER][NEUTRAL] And date of birth [PII].
[AGENT][NEUTRAL] OK, alright, let me look up that policy real quick.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] OK, and then what is the date of service please? and the charge amount?
[CUSTOMER][NEUTRAL] For the date of service, that is [PII] and billed amount $209.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] That is $40. I'm sorry, $20.
[AGENT][NEUTRAL] $20 OK. And then
[CUSTOMER][NEUTRAL] Which is
[AGENT][NEUTRAL] And can you give me the um name of the facility you're calling for?
[CUSTOMER][NEUTRAL] Free my health?
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I look up this claim for you and I'll be right back. Thank you, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I can
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Special
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 330
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you, Ms. [PII] for holding for me. I did find the claim. The claim number is 3,304,650.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim was denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] Let me just um repeat the claim number because you actually cut off but that will be 3,304,650.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and you said for this visit of this visit is not covered?
[CUSTOMER][NEUTRAL] Under the vision.
[AGENT][NEUTRAL] Right, office visit.
[AGENT][NEUTRAL] Right, office visits. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, I see.
[CUSTOMER][NEUTRAL] And for this one since we actually haven't yet received the updated EOB in regards on this claim, is it possible you guys can submit it to us?
[AGENT][NEUTRAL] Yes, um, give me your fax number and I'll fax it over to you.
[CUSTOMER][NEUTRAL] OK, perfect. So, for the fax number, that will be [PII]. Attention to my name is, which is [PII].
[AGENT][NEUTRAL] OK, Miss [PII].
[AGENT][NEUTRAL] I'm gonna put you on hold again so I can get this fax ready for you and I'll be right back.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[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][POSITIVE] Thank you for holding for me, [PII]. I've got that on its way to you now.
[CUSTOMER][NEUTRAL] OK, perfect. And may I know what will be the turnaround time for us to be able to receive the EOB?
[AGENT][NEUTRAL] You just have to give it a chance to get to you I've sent it through the fax.
[CUSTOMER][NEUTRAL] OK, I see.
[CUSTOMER][NEUTRAL] OK. Let me just take note of that here.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] And one thing, sorry, um, can you provide to me a reference number for discount?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][POSITIVE] OK, thank you so much for this one sorry you have a great day ahead to you.
[AGENT][POSITIVE] You're very welcome, Miss [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] Um, no, that will be all.
[AGENT][POSITIVE] OK well you have a wonderful weekend and thank you for calling APL.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Bye-bye.