AccountId: 011433970860
ContactId: 3b9157ed-dc10-40ee-aea0-dad576b671d9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 220210 ms
Total Talk Time (AGENT): 71051 ms
Total Talk Time (CUSTOMER): 56149 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/3b9157ed-dc10-40ee-aea0-dad576b671d9_20250116T21:39_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah. Hi, [PII]. This is calling from provider's office regarding the claim status.
[AGENT][NEUTRAL] Alright, [PII], I'm happy to check on a claim today. What is the patient's policy number?
[CUSTOMER][NEUTRAL] It's A as in Alpha, 6,014,516,200.
[AGENT][NEUTRAL] That's too long to be one of our policy numbers. Do you have their name or social? I can search that way.
[CUSTOMER][NEUTRAL] I have the patient name and the date of birth.
[AGENT][NEUTRAL] What's the name?
[CUSTOMER][NEUTRAL] It's [PII] and the last name is [PII]
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Uh, may I please have [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Uh, the date of birth is [PII].
[AGENT][POSITIVE] Thank you so much and then what is the date of service?
[CUSTOMER][NEUTRAL] The service is [PII], with the amount of $150.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, so it looks like the claim was received on [PII]. Claim was denied. Office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] Um, what is the denial date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And is there any claim number or anything else?
[AGENT][NEUTRAL] 352-837-0
[CUSTOMER][NEUTRAL] So what is the next action that we need to take on this claim?
[AGENT][NEUTRAL] I'm sorry, what was that again, [PII]?
[CUSTOMER][NEUTRAL] Uh, what is the next action that we need to take on this claim?
[AGENT][NEGATIVE] We're not able to advise on the next action. It was denied because the member's plan does not cover office visits. It's up to the provider facility to build the patient.
[CUSTOMER][NEUTRAL] OK, no problem. Just provide me the reference number.
[AGENT][NEUTRAL] Call reference is my name with my last initial in today's date. My name again is [PII], that is spelled [PII] Last initial to my name is [PII].
[CUSTOMER][NEUTRAL] And today's date, right? OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII]. Have a nice day. Bye-bye.
[AGENT][POSITIVE] You're welcome. Have a good day. Bye bye.