AccountId: 011433970860
ContactId: 4efae56c-76fa-4281-91fb-2d1bab35239d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 232880 ms
Total Talk Time (AGENT): 123202 ms
Total Talk Time (CUSTOMER): 69994 ms
Interruptions: 0
Overall Sentiment: AGENT=3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/09/4efae56c-76fa-4281-91fb-2d1bab35239d_20250109T18:29_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I am calling on claim status for a patient.
[AGENT][POSITIVE] OK [PII], I'd love to help you with claim status today and can I get a good call back number from you real quick, my friend?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] 02047435
[AGENT][POSITIVE] Perfect and give me a moment to get that pulled up for you.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Wonderful. And can you please verify for me your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Um, it's [PII], [PII].
[AGENT][POSITIVE] Perfect thank you so much and do you have that claim number or the date of service I can search for?
[CUSTOMER][NEUTRAL] Um, I have a date of service. It's November [PII], 2024.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Wonderful, hang tight.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Can you verify the name of the provider or the facility name?
[CUSTOMER][NEUTRAL] It's Doctor [PII].
[AGENT][NEUTRAL] And I'm so sorry. I guess I'm at the facility name.
[CUSTOMER][NEUTRAL] Uh, SGMC physician Network.
[AGENT][POSITIVE] Wonderful. Thank you so much. I appreciate that. Um, I do have your claim here. It looks like we received your claim on 12-13-2024, and it looks like we processed the claim on 12-17-2024. Your claim number is 3541086.
[AGENT][NEUTRAL] And it looks like that claim was denied, the reason stating that office visits are not covered by the above numbered policy.
[CUSTOMER][NEGATIVE] Office visits are not covered.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] May I get a copy of that denial EOB?
[AGENT][POSITIVE] Yeah, absolutely. Let me get that pulled up for you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And I am just waiting for that fax dialogue box to open, um, but when it does, are you gonna want me to make that attention to yourself or to the patient account number?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] Perfect, Miss [PII]. And then what is gonna be the phone number we send that to?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] That's I'm so sorry that's my um work number um.
[AGENT][POSITIVE] You're OK.
[CUSTOMER][NEUTRAL] The fax number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, so I have [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Perfect. All right, Ms. [PII], I am hitting send on that um for you right now. It should be there in about 5 to 15 minutes.
[AGENT][NEUTRAL] And then is there anything else I can do for you today?
[CUSTOMER][NEUTRAL] Uh, just a claim number please.
[AGENT][NEUTRAL] Oh, I'm sorry, 354.
[CUSTOMER][NEUTRAL] I mean, not the
[CUSTOMER][NEUTRAL] Uh girl, it's time for me to go home. Yes, the reference number. Oh my god.
[AGENT][NEUTRAL] The reference number?
[AGENT][NEUTRAL] No worries. It is my name [PII], first initial last name, [PII] like boy in today's date.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] My pleasure, Miss [PII]. Thank you for calling APL. I hope you have a fabulous day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thanks bye bye.
[CUSTOMER][NEUTRAL] Goodbye.