AccountId: 011433970860
ContactId: 50192f16-7528-4e55-8f27-98e4633ac9eb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 207440 ms
Total Talk Time (AGENT): 69774 ms
Total Talk Time (CUSTOMER): 82116 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/50192f16-7528-4e55-8f27-98e4633ac9eb_20250328T22:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from provider's office. Check the client status.
[AGENT][POSITIVE] OK, [PII], I'm happy to check on a claim for you today. Can I get the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, which is 02449775.
[AGENT][NEUTRAL] OK, thank you, [PII]. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Contact number is [PII] direct line or extension.
[AGENT][NEUTRAL] Thank you. Patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh, patient first name is [PII]. Last name is [PII], and his date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And then what is the date of service?
[CUSTOMER][NEUTRAL] Data services [PII].
[CUSTOMER][NEUTRAL] And uh the total charge amount I have which is $242 even $242.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] So it looks like we did receive a claim for this state of service. Uh, the claim was denied office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] OK, ma'am, so the office visit is not covered under the patient plan whether you, I need to know whether this claim is processed as primary or secondary.
[AGENT][NEUTRAL] Or the secondary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then may I know when the claim is denied?
[AGENT][NEUTRAL] Claims denied [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. May I get the claim number?
[AGENT][NEUTRAL] That would be 3,572,590.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] May I know the receipt detail as well?
[AGENT][NEUTRAL] Claim is received on [PII].
[CUSTOMER][NEUTRAL] OK, so I need to know what type of plan the patient have and why the office was is not covered under the patient plan.
[AGENT][NEUTRAL] Uh, patient has a secondary medin plan.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the policy that the patient has does not cover office visits.
[CUSTOMER][NEUTRAL] Um, there's many, uh, specific claim like HMO access like that right.
[AGENT][NEUTRAL] No, this is just a secondary, this is just a secondary plan. It's not an HMO or anything like that.
[CUSTOMER][NEUTRAL] The brand name.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Um, thank you very much, ma'am. I'm ready for the call reference number.
[AGENT][NEUTRAL] Call references my name with my last initial, then today's date. My name again is [PII], that's [PII] Last initial is [PII].
[CUSTOMER][POSITIVE] OK. Thank you. Have a great day. Bye, ma'am.
[AGENT][NEUTRAL] You too, [PII]. Bye bye.