AccountId: 011433970860
ContactId: 3cfa7e6c-3d57-4fbe-a35a-1d5703058591
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 258428 ms
Total Talk Time (AGENT): 53076 ms
Total Talk Time (CUSTOMER): 82237 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/3cfa7e6c-3d57-4fbe-a35a-1d5703058591_20250408T17:05_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah. Hi, this is [PII], and his last, my last name is [PII]. We are calling from provider's office regards to claim status.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] Great, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes. Our callback number is [PII].
[AGENT][NEUTRAL] And the policy number of the patient?
[CUSTOMER][NEUTRAL] Yes. The ID number is
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 025
[CUSTOMER][NEUTRAL] 381
[CUSTOMER][NEUTRAL] 01
[CUSTOMER][NEUTRAL] M as in Mike, L as in Lima.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Number 8
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Yes. First name is [PII]. Last name is [PII].
[CUSTOMER][NEUTRAL] With the date of birth of [PII].
[AGENT][NEUTRAL] OK, what was the date of service?
[CUSTOMER][NEUTRAL] Yes, for this member data services, [PII].
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] For $5,234. 47 cents.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, it looks like that claim was received 12-2-2024. Pro 12-2-2024.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] A claim was denied, service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And can I get the claim number?
[AGENT][NEUTRAL] Claim number is 353-612-1.
[CUSTOMER][NEUTRAL] OK. Uh, just give me a moment, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK. Uh, thank you for staying on the line. So I just want to confirm the claim has been denied for the place of service.
[CUSTOMER][NEUTRAL] Under patient plan.
[AGENT][NEUTRAL] Um
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] So the patient plan does not cover office with services, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK. Uh, so in this case, can we bill the patient, right?
[AGENT][NEUTRAL] Um, we are a secondary policy, so we do not determine patient responsibility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please spell your name for me?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][POSITIVE] Once again, thank you so much, [PII], for this info. Have a wonderful day.
[AGENT][POSITIVE] Thank you for calling APL. You have a great day too.
[CUSTOMER][NEUTRAL] Bye-bye.