AccountId: 011433970860
ContactId: 38d47f66-224d-4eec-a8a8-a0eb62bd0b65
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 908070 ms
Total Talk Time (AGENT): 208580 ms
Total Talk Time (CUSTOMER): 234152 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/38d47f66-224d-4eec-a8a8-a0eb62bd0b65_20250117T21:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi. This is [PII] calling from provider's office. I want to check the claim status.
[AGENT][POSITIVE] OK, [PII], I'm happy to check on a claim for you today. What is the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. It's um 019894.
[CUSTOMER][NEUTRAL] 36, M as in Mike, L as in Lima, number 7.
[AGENT][POSITIVE] Thank you for that. And do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, sure. It's uh [PII].
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. Uh, what is the date of service?
[CUSTOMER][NEUTRAL] Yeah, sure. The date of service is on [PII] and the total charge amount is $2,398 even.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And I apologize, [PII], what was the bill amount again? 2000.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 2398.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] So looks like we did receive this claim on [PII].
[AGENT][NEGATIVE] Claim was denied. The services are not covered in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] So when it has been denied?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] On [PII] itself.
[AGENT][NEUTRAL] We received the claim on [PII]. The claim was processed on [PII].
[CUSTOMER][NEUTRAL] So, the claim has been denied because of non-covered services. Of visits are not covered.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Mm, Services are not covered in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] Can you repeat that once again?
[AGENT][NEUTRAL] Services.
[AGENT][NEGATIVE] are not covered.
[AGENT][NEUTRAL] In a doctor's office or clinic?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Under patients plan?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and can you give me the claim number?
[AGENT][NEUTRAL] 342-598-3.
[CUSTOMER][NEUTRAL] And can you please fax the UOB I will provide my fax number.
[AGENT][NEUTRAL] Mhm, what's the fax?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 7773536
[AGENT][NEUTRAL] [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. That is on its way. Is there anything else I can check for you today?
[CUSTOMER][NEUTRAL] Yeah, and I have another patient to check, so can you please check that?
[AGENT][NEUTRAL] Yeah, just one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Yeah, just one moment and I'll be ready for the next policy number. I'm just finishing my note here.
[CUSTOMER][NEUTRAL] Mhm. No, OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, [PII], what's the next policy number?
[CUSTOMER][NEUTRAL] 02144558 M as in Mike, L as in Lima.
[CUSTOMER][NEUTRAL] Number 8.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you. Data service?
[CUSTOMER][NEUTRAL] [PII] and the total charge amount is $237 even.
[AGENT][NEUTRAL] Claim was received on [PII].
[AGENT][NEUTRAL] Uh, claim was denied, office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] OK. And when it has been denied?
[AGENT][NEUTRAL] Claim was denied [PII] as well.
[CUSTOMER][NEUTRAL] And claim number?
[AGENT][NEUTRAL] 344-3891
[CUSTOMER][NEUTRAL] Yeah, and can you please fax the UOB? I will provide my fax number.
[AGENT][NEUTRAL] Uh yes, I still have it here. [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I will send that now.
[AGENT][NEUTRAL] Is there anything else I can check on for you today, [PII]?
[CUSTOMER][NEUTRAL] Mhm. And I have another patient to check, so can you please check that?
[AGENT][NEUTRAL] Yeah let me just finish sending the COB to you one moment.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, [PII], what's the next policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. One moment.
[CUSTOMER][NEUTRAL] Yeah, the next policy number is 0198.
[CUSTOMER][NEUTRAL] 943 8 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you. Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's uh [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you data service.
[CUSTOMER][NEUTRAL] [PII] and the total charge amount is $1,938 even.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] posting.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Depending on the day.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Right, so it looks like we did receive this claim on.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] A claim was denied on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Services are not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK, and can you give me the claim number?
[AGENT][NEUTRAL] Uh, claim number is going to be 352-9739.
[CUSTOMER][NEUTRAL] Uh, and can you please fax the EOB?
[AGENT][NEUTRAL] Mhm. One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Right, so that has been sent. Do you have any others?
[CUSTOMER][NEUTRAL] Yes, and I have last one more patient to check.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, what is the policy number?
[CUSTOMER][NEUTRAL] 02462085 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you. Patient name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII] and the date of birth is uh [PII].
[AGENT][NEUTRAL] Data service
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEGATIVE] Bull them out.
[CUSTOMER][NEUTRAL] It's um bill amount is $250 even.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] We did receive this claim [PII].
[AGENT][NEUTRAL] Uh, the claim was denied same date [PII]. Office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] Can you give me the claim number?
[AGENT][NEUTRAL] 353-622-4
[CUSTOMER][NEUTRAL] Can you please fax it for me?
[AGENT][NEUTRAL] Mhm, yep, I'm sending that now.
[CUSTOMER][NEUTRAL] it up.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] EOB is on its way, [PII]. You should have all those within the next 5 minutes, OK?
[CUSTOMER][NEUTRAL] Yeah, OK. And can you spell your name?
[AGENT][NEUTRAL] My name is spelled [PII].
[AGENT][NEUTRAL] The call reference is my name with my last initial in today's date. The last initial to my name is [PII].
[CUSTOMER][POSITIVE] Mhm. Yeah. OK. Thank you. Thank you so much.
[AGENT][POSITIVE] You're welcome. Bye-bye.
[CUSTOMER][POSITIVE] Have a good, have a good day. Bye-bye.