AccountId: 011433970860
ContactId: 4d907f0a-b186-49c4-8bb9-d981024a8b44
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 380440 ms
Total Talk Time (AGENT): 97251 ms
Total Talk Time (CUSTOMER): 119145 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/4d907f0a-b186-49c4-8bb9-d981024a8b44_20250121T19:09_UTC.wav
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[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] For payment details.
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from provider's office to check on a claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with the claim. Can you please give me your callback number?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][POSITIVE] Good thank you and what's the patient's name?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh yes. The patient name is [PII]. It's [PII]
[CUSTOMER][NEUTRAL] [PII], it's [PII] and the last name is [PII]. It's [PII]
[AGENT][NEUTRAL] OK, thank you. And then what is the patient's date of birth?
[CUSTOMER][NEUTRAL] Uh, date of birth is [PII].
[AGENT][NEUTRAL] And patients policy number, sir.
[CUSTOMER][NEUTRAL] Uh yes. The patient policy number is 02501795.
[AGENT][NEUTRAL] OK, let me pull up the policy real quick, [PII].
[AGENT][NEUTRAL] OK, I've got the policy pulled in. What is the date of service?
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Uh yes, the date of service for this claim is [PII].
[AGENT][NEUTRAL] OK, and the charge amount?
[CUSTOMER][NEUTRAL] Uh, the total charge amount for this one is $2430.89.
[AGENT][NEUTRAL] Thank you. And then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, let me check.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] Uh, no, upon checking here, I don't see any other insurance on file.
[CUSTOMER][NEUTRAL] Let me just check it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Why you that.
[AGENT][NEUTRAL] And what is the name of the facility you're calling for, [PII]?
[CUSTOMER][NEUTRAL] Uh, it's Doctor Hospital of Augusta.
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, [PII], while I look up this claim for you and I'll be right back.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding for me [PII]. I did find the claim and the claim number is 352-731-4.
[AGENT][NEUTRAL] The claim was received on [PII].
[CUSTOMER][NEUTRAL] No nothing.
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the claim was denied because we need the EOB from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK. What's the primary insurance?
[AGENT][NEUTRAL] I don't have that information.
[CUSTOMER][NEUTRAL] OK, I don't have the information. OK, thank you for that. Uh, tell me when was the last time, uh, COV was updated?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] When the last time, what, sir?
[CUSTOMER][NEUTRAL] Uh, COB coordination of benefits.
[AGENT][NEUTRAL] I don't, I don't have that information.
[CUSTOMER][NEUTRAL] OK. If I have to update the COV how can the member update this? Uh, do they have to call the insurance?
[AGENT][NEUTRAL] I guess you'll have to get that information from the patient.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] Just a minute.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEUTRAL] Uh, and what will be the call reference number?
[AGENT][NEUTRAL] You can use my name [PII] and today's date.
[CUSTOMER][NEUTRAL] Today's date.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. How do we have to update the COV?
[CUSTOMER][NEUTRAL] Via fax
[AGENT][NEUTRAL] Um, no, I don't have the COV.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The policy is, was, uh, the policy is effective [PII] and it's still active.
[CUSTOMER][POSITIVE] OK, no problem. Thank you.
[CUSTOMER][POSITIVE] OK. So I don't have that information. OK, thank you for that information and have a nice day. Bye-bye.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You too, [PII]. Thank you.