AccountId: 011433970860
ContactId: 54fb1274-60c1-4de3-9070-6f49a4cfef4d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 471920 ms
Total Talk Time (AGENT): 189004 ms
Total Talk Time (CUSTOMER): 127734 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/54fb1274-60c1-4de3-9070-6f49a4cfef4d_20250220T14:12_UTC.wav
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[AGENT][NEUTRAL] Morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check on the claim status.
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status, Mr. [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Can you repeat that one more time? [PII]?
[CUSTOMER][NEUTRAL] No, no, no. It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the next one?
[CUSTOMER][NEUTRAL] And then [PII].
[AGENT][NEUTRAL] [PII]. OK. Extension [PII].
[CUSTOMER][NEUTRAL] Extension, extension [PII].
[AGENT][NEUTRAL] Mhm, I got that one. Thank you. All right. And may I have the patient's policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] 8223.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Policy number is 0234.
[CUSTOMER][NEUTRAL] 479 4.
[AGENT][NEUTRAL] Thank you. One moment. Let me pull up that information.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Sure. My name is [PII] and the last name, uh date of birth is uh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect, thank you. May I have the
[CUSTOMER][NEUTRAL] Before that, could you spell your name for me?
[AGENT][NEUTRAL] Sure. That's [PII]. That's initial [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. [PII] then?
[AGENT][NEUTRAL] Yes, that's it.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] The last initial [PII].
[CUSTOMER][NEUTRAL] No, no, so it
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], right? So.
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sir. Uh,
[CUSTOMER][NEUTRAL] D of is uh [PII].
[AGENT][NEUTRAL] [PII]. And how much is the total charge?
[CUSTOMER][NEUTRAL] $273.07.
[AGENT][NEUTRAL] All right, let me see if I can find this claim. And for future, you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] Can you,
[CUSTOMER][NEUTRAL] Can you uh repeat that, [PII]?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But, how was your day?
[AGENT][POSITIVE] I'm good, thank you.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I think it's gonna be a minute and I'm waiting on the EOB to pull up.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Do you find any claim for this kind of service?
[AGENT][NEUTRAL] Yes, I'm waiting on this explanation of benefits to pull up. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] 8654.
[CUSTOMER][NEUTRAL] Can you be able to fax me the exploration of benefits?
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. I have one.
[CUSTOMER][NEUTRAL] But current, but now for now.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] But now, can you, can you, you can give the status?
[AGENT][NEUTRAL] Yes, yes, and uh let me repeat that, the fax number is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] To your attention or to what attention?
[CUSTOMER][NEUTRAL] My attention.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, it looks like um let's see 9654. We received the claim [PII] processed [PII], um, the claim was denied. The reason for this denial is let's see.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, it's not a covered place of service.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Non-covered service, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So what needs to be done for this?
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] We should tell
[CUSTOMER][NEUTRAL] So for this, what needs to be done?
[AGENT][NEUTRAL] OK, it was denied because it's not payable by the policy under the member's plan, so it's up to the provider's discretion. Um, you have 180 days from the decision date to submit any appeals if you would like to submit an appeal, um, but it is denied because it's not payable under the member's plan.
[CUSTOMER][NEUTRAL] OK, I will send the bill. Can you give me the bill mailing address?
[AGENT][NEUTRAL] Yes, that is [PII].
[CUSTOMER][NEUTRAL] One moment. [PII].
[AGENT][NEUTRAL] No
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 24
[AGENT][NEUTRAL] 8
[CUSTOMER][NEUTRAL] 8
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], mhm, yes, in [PII].
[CUSTOMER][NEUTRAL] [PII] then?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, um [PII].
[CUSTOMER][NEUTRAL] [PII], correct?
[AGENT][POSITIVE] Correct, yes. Mhm.
[CUSTOMER][NEUTRAL] Then payer ID, uh sorry, payer ID, uh, uh, TFL.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, for this one, it is going to be 60801.
[CUSTOMER][NEUTRAL] What is 6001?
[AGENT][NEUTRAL] That's the payer ID for this one. This one is a uh hospital indemnity, so you can send it electronically. This is not a secondary.
[AGENT][NEUTRAL] So this one you can send it electronically. 60801.
[CUSTOMER][NEUTRAL] What do you Phil?
[CUSTOMER][NEUTRAL] Dear.
[AGENT][NEUTRAL] Timely filing 180 days if you're trying to submit an an appeal.
[CUSTOMER][NEUTRAL] OK. Then uh fax number?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Do you mind holding while I send this fax out to you, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yeah, you can fax me the UOB to my fax number.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I got the fax number. Let me go ahead and fax it over to you. Do you mind holding for me so I can fax it right now.
[CUSTOMER][NEUTRAL] OK. I just, yeah, that's all for today. Can you give me call first number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's gonna be my name in today's date. Can you hold so I can send that fax, Mr. [PII]? I need to send it before I let you go. Can you hold for me?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.