AccountId: 011433970860
ContactId: 468e0fd5-7de3-4575-b38c-0db2084b4768
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 302510 ms
Total Talk Time (AGENT): 108076 ms
Total Talk Time (CUSTOMER): 92418 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/468e0fd5-7de3-4575-b38c-0db2084b4768_20250402T15:58_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling from provider's office, and today I just want to discuss about the denied claim. Could you please help me with that?
[AGENT][NEUTRAL] Sure, I can assist you with claims. And may I have a callback number just in case we get disconnected, Mr. [PII]?
[CUSTOMER][NEUTRAL] Um, sure, the callback number that is [PII].
[AGENT][NEUTRAL] Thank you. And what's the name of the facility or the doctor's office you're calling from?
[CUSTOMER][NEUTRAL] I'm calling from Dage Medical Group.
[AGENT][NEUTRAL] OK, and may I have the patient's policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] I'm sure the member's ID number that is 02007928.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] And while you check in your system, may I know how to spell out your name?
[AGENT][NEUTRAL] That's [PII], last [PII] [PII].
[CUSTOMER][NEUTRAL] OK sir, got it.
[AGENT][NEUTRAL] All right. And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] with the date of birth, um.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, and what is the date of service and the amount of the claim or the claim number?
[CUSTOMER][NEUTRAL] Um, so the date of service that is [PII] with the bill amount $157 even.
[CUSTOMER][NEUTRAL] Um, shall I provide you the claim number as well?
[AGENT][NEUTRAL] Yeah, sure, go ahead.
[CUSTOMER][NEUTRAL] So the claim number that is 353-346-6.
[AGENT][NEUTRAL] OK, let me look at that please.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] One moment. Let me pull the image.
[CUSTOMER][NEUTRAL] Sure, when I'm checking here, sure, sure.
[AGENT][NEUTRAL] OK, you're waiting on the EOB. OK, one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] All right. So I see that, mhm, go ahead. Go ahead.
[CUSTOMER][NEUTRAL] While it is opening, should I tell you what is it?
[CUSTOMER][NEUTRAL] Yeah, go ahead.
[CUSTOMER][NEUTRAL] OK. You first.
[AGENT][NEUTRAL] Go ahead with your question.
[AGENT][NEUTRAL] OK, so I see that we processed and denied stating that office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Um, you mean to say.
[CUSTOMER][NEUTRAL] Uh, in this plan, the office visit is not covered, right?
[AGENT][POSITIVE] Correct. That's correct.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Just give me a moment
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And so, may I know uh which type of plan patient has?
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical.
[CUSTOMER][NEGATIVE] You please repeat one more time, actually your voice is break.
[AGENT][NEUTRAL] Sure. This is a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] OK, got it. May I know the reference number for our call?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's state if you will.
[CUSTOMER][POSITIVE] Yeah, got it.
[CUSTOMER][NEUTRAL] And um sorry to ask, but could you please uh spell out what uh which type of plan patient has.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Please spell the plan name.
[AGENT][NEUTRAL] Um, which one, like a secondary policy or the supplemental policy? Which one do you need me to spell?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] The 2nd 1
[AGENT][NEUTRAL] Supplemental.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then
[AGENT][NEUTRAL] One moment, I have to write it down.
[AGENT][NEUTRAL] OK, so you can spell that out as let's see.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, SU.
[AGENT][NEUTRAL] PP
[AGENT][NEUTRAL] EM
[AGENT][NEUTRAL] EN
[AGENT][NEUTRAL] T A L.
[CUSTOMER][POSITIVE] OK, got it. Thank you so much, [PII] for assisting and providing this information. Have a great day. Bye for now.
[AGENT][POSITIVE] You as well, Mr. [PII]. Have a good day and thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] But