AccountId: 011433970860
ContactId: 3895f8b1-2843-4599-bd9c-735ea6a67dec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 249559 ms
Total Talk Time (AGENT): 89754 ms
Total Talk Time (CUSTOMER): 72746 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/3895f8b1-2843-4599-bd9c-735ea6a67dec_20250103T15:08_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, this is [PII] calling from the provider's office, and I'm looking for about a patient claim status.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with claim status. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] uh with the extension of uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] Other policy number, just a moment.
[CUSTOMER][NEUTRAL] Uh, the claim number will be, sorry, uh, the patient member ID will be 01665298.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Officient name is [PII] and the date of birth is uh [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] Uh, the date of services for [PII] for uh.
[CUSTOMER][NEUTRAL] $152 and even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, we did receive that claim. We received that claim on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3,462,200.
[CUSTOMER][NEUTRAL] The information and uh is the claim whether it is paid.
[AGENT][NEUTRAL] Um, no, I'm showing that this claim denied because, um, according to the diagnosis codes, this claim was for screenings and screenings are not covered under the policy. The diagnosis code would have to be related to an illness or an injury.
[CUSTOMER][NEUTRAL] Uh, sure. So the screening coverage is not for the patient?
[AGENT][NEUTRAL] That's right. It's not covered under this policy.
[CUSTOMER][NEUTRAL] OK, and uh if uh just to confirm that, uh.
[CUSTOMER][NEUTRAL] Uh, can I know the patient policy effective dates and the term dates?
[AGENT][NEUTRAL] Um, I'll get that information for you. One moment.
[AGENT][NEUTRAL] OK. Thanks for your patience and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII].
[AGENT][NEUTRAL] And this policy expired on [PII].
[CUSTOMER][NEUTRAL] The [PII]. OK, thank you for the information. And uh just to confirm that, uh, can we, can we build this uh patient uh service for the patient?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] Yes, sir, you can.
[CUSTOMER][NEUTRAL] Thank you for the information. Uh, oh, sorry, I, I have forgetted to document this evening.
[AGENT][NEUTRAL] Um, please repeat your question.
[CUSTOMER][NEUTRAL] Your name, please?
[AGENT][NEUTRAL] My name is [PII]. Um, it's spelled [PII] and last initial is [PII], and my name and today's date is your reference number.
[CUSTOMER][POSITIVE] Thank you, thank you for the information and I wish you have a nice day.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL bye.