AccountId: 011433970860
ContactId: 49e5293a-f8b9-41e2-a2e2-4a33d776cdf3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 676159 ms
Total Talk Time (AGENT): 177877 ms
Total Talk Time (CUSTOMER): 156788 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/49e5293a-f8b9-41e2-a2e2-4a33d776cdf3_20250414T19:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check on a claim status. Actually, I'm here to check on a denial.
[CUSTOMER][NEUTRAL] Clarification.
[AGENT][NEUTRAL] OK, I, OK, [PII], I can help you with claim status. And can you please give me your callback number, sir, just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. Uh my callback number is gonna be [PII]. Could you please spell out your name?
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] For my documentation.
[AGENT][NEUTRAL] Yes, sir. It's [PII]
[AGENT][NEUTRAL] And may I please get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Yup, sure. The patient's policy number is gonna be 01699850 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, the patient's name is [PII].
[AGENT][NEUTRAL] OK, and
[AGENT][NEUTRAL] His birthday.
[CUSTOMER][NEUTRAL] Uh, the birthday is gonna be on [PII].
[AGENT][POSITIVE] OK, thank you so much for giving me that information and what is the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Um, the date of service is [PII].
[CUSTOMER][NEUTRAL] For the bill amount of $172.74 dollars even.
[AGENT][NEUTRAL] 174. OK. And then what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Mhm. Could you please repeat?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello? The charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Yeah, the primary pay the part and the balance is $35 and uh you have been divided the services not covered, so I need a clarification on that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what, um.
[AGENT][NEUTRAL] Is the name of the facility you're calling from, sir?
[CUSTOMER][NEUTRAL] Hm, the name of the facility I'm calling from is.
[CUSTOMER][NEUTRAL] Cleveland Clinic, Florida.
[AGENT][NEUTRAL] OK, thank you. And you said the claim has already been denied, do you have the claim number?
[CUSTOMER][NEUTRAL] Um, yup.
[AGENT][NEUTRAL] What is that, please?
[CUSTOMER][NEUTRAL] The claim number is 3581947.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold [PII] while I look this up and I'll be right back with you.
[CUSTOMER][POSITIVE] Yeah, OK. Thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding for me. I do have the claim pulled up, um, and you have the claim number 3581947.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it has a remark on there that
[CUSTOMER][NEUTRAL] Yup.
[AGENT][NEUTRAL] Benefits are payable under the certificate are limited to those outlined on the schedule of benefits. This is not a covered loss under the plan. Therefore, no amount is payable for this expense.
[AGENT][NEUTRAL] So
[AGENT][NEGATIVE] It was denied because it's non-covered.
[AGENT][NEUTRAL] And let me give you the correct policy number.
[AGENT][NEUTRAL] That that claim is under.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I mean, uh, could you please repeat that?
[AGENT][NEUTRAL] It is 24.
[AGENT][NEUTRAL] It's non-covered under the patient's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, may I get the patient's plan type?
[AGENT][NEUTRAL] Medlink, M E D L I N K.
[CUSTOMER][NEUTRAL] Midlink
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, meddling plan, got it.
[CUSTOMER][NEUTRAL] Mm. According to the patient,
[AGENT][NEUTRAL] Would you like the correct policy number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. The correct policy number is 2473415.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You're studying like according to the patient plan name, it is a non-covered charges, am I right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. Can we move to the next one? I have one more claim.
[AGENT][NEUTRAL] OK, let me put my note on this one and we'll move on to the next one.
[CUSTOMER][NEUTRAL] Can I get a reference number also for this one?
[AGENT][NEUTRAL] Uh, yes, for both of them, it'll be my name, [PII], and today's date.
[CUSTOMER][NEUTRAL] to this data. I got it.
[AGENT][NEUTRAL] OK. And what is the next patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um, can you please give me a second? Let me document on this thing.
[AGENT][NEUTRAL] Sure. Yeah, just let me know when you're ready.
[CUSTOMER][POSITIVE] OK make it for you.
[CUSTOMER][POSITIVE] Yeah, I'm ready. Can I do that?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello. Uh, the policy number is 02550885 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, let me pull that in real quick.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then what is the data service and the charge amount?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 37 of 2025 for the bill amount of $174.
[AGENT][NEUTRAL] OK, and then the charges after primary?
[CUSTOMER][NEUTRAL] $35.
[AGENT][NEUTRAL] And is it for the same facility, Cleveland Clinic, Florida?
[CUSTOMER][NEUTRAL] Yup. Yeah.
[AGENT][NEUTRAL] OK, brief hold again I'm gonna look this one up and I'll be right back with you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], this is [PII] back with you again. So I've got the claim pulled up. The claim number is 3581945.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim was also denied for the same reason. It's a non-covered service under the patient's plan.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] OK, the same patient plan, right?
[AGENT][NEUTRAL] Right Medlink.
[CUSTOMER][POSITIVE] OK, got it. Thank you. Have a nice day. Bye bye.
[AGENT][POSITIVE] You too. I hope you have a wonderful day also is that all I can help you with before we go?
[CUSTOMER][POSITIVE] No, nothing else, thank you.
[AGENT][NEUTRAL] Thank you for calling APL. Bye bye [PII].