AccountId: 011433970860
ContactId: 48070c8f-171c-4bbe-896a-2a400e01857e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 521619 ms
Total Talk Time (AGENT): 140470 ms
Total Talk Time (CUSTOMER): 93581 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/48070c8f-171c-4bbe-896a-2a400e01857e_20250318T16:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help?
[CUSTOMER][NEUTRAL] Hello, this is the shut up in provider's office. How are you?
[AGENT][POSITIVE] I'm doing good and you said your name was [PII]?
[CUSTOMER][NEUTRAL] My name is [PII]. It is spelled as [PII].
[AGENT][POSITIVE] OK, thank you, [PII]. I appreciate that. And what is your callback number and the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] [PII] and the extension is [PII].
[AGENT][POSITIVE] OK, and how can I help you today?
[CUSTOMER][NEUTRAL] Claim status?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can help you with the claim status. What is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Name is uh OK, the policy number is 02369694.
[CUSTOMER][NEUTRAL] And the name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] OK, let me pull up that policy real quick.
[AGENT][NEUTRAL] OK and then what is the date of service?
[AGENT][NEUTRAL] And the charge amount.
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] The total charge amount of.
[CUSTOMER][NEUTRAL] Give me a 2nd. $540 even.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] $35?
[AGENT][NEUTRAL] OK. Thank you. And then can you please give me the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] It's uh Lo P psychiatry and Wellness.
[AGENT][NEUTRAL] OK, can you spell that for me, please?
[CUSTOMER][NEUTRAL] L O T U S
[CUSTOMER][NEUTRAL] Psychiatry and wellness, otherwise known as PA the psychiatric services.
[AGENT][POSITIVE] OK, thank you. I appreciate that.
[AGENT][NEUTRAL] I'm gonna put you on a brief hold while I look up this claim and I will be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Well,
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. I've got the claim pulled up. It's under a different policy number, so let me give you that good policy number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, the policy number is 251-8146.
[AGENT][NEUTRAL] The claim number is 3563145.
[AGENT][NEUTRAL] And the claim was denied for two reasons. One is office visits is not covered under the patient's plan, and then the other is insurance primary insurance provided full benefits, there are no benefits payable.
[CUSTOMER][NEUTRAL] Can you please repeat that?
[AGENT][NEUTRAL] Yes, the insured's primary insurance provided full benefits. There are no benefits payable.
[AGENT][NEUTRAL] And then also, office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Just give me a second.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Perfect. And for the date of service that is [PII]. What about that? It has the same issue?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, for [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, let me look on that data service.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And is the charge amount the same?
[CUSTOMER][NEUTRAL] Uh, $35 yes.
[AGENT][NEUTRAL] OK, alright, brief hold I'm gonna pull that one up. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Did you say that data of service was [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, we do not have a claim on file for that date of service.
[CUSTOMER][POSITIVE] Perfect callerence number?
[AGENT][NEUTRAL] It's going to be my name, [PII], and today's date.
[CUSTOMER][NEUTRAL] What is your name? Uh, can you spell that?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] and the last name?
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] And what is the date? [PII].
[CUSTOMER][POSITIVE] Perfect. Thank you so much, [PII]. It was nice talking to you. Have a nice day.
[AGENT][NEUTRAL] You too, [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] No that's all.
[AGENT][POSITIVE] Alright well you have a good day too and thank you for calling APL.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Bye bye.