AccountId: 011433970860
ContactId: 57e4f478-7456-4f33-974e-6e2fc669644d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 224660 ms
Total Talk Time (AGENT): 84440 ms
Total Talk Time (CUSTOMER): 68271 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/57e4f478-7456-4f33-974e-6e2fc669644d_20250528T13:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name's [PII]. I'm calling from uh Brown Health Medical Group. I need to get medical status on two medical claims for a patient, please.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with the claim status. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII], and that's a direct line.
[AGENT][NEUTRAL] Thank you. Now I need the first policy number.
[CUSTOMER][NEUTRAL] Um, policy number I'm showing is 02586419.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], uh last name [PII] true um date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. Now, I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] OK, um, as I said, it's two claims, same patient data services the same 426 2025. Bill out on one of the claims is $385 and the other one is $84 even.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, yes, sir. The claim for $385. Um, we received that one on [PII].
[AGENT][NEUTRAL] It processed on [PII].
[AGENT][NEUTRAL] The claim number is 3602023.
[AGENT][NEUTRAL] And I'm showing that this claim denied because under this policy, we only cover charges um for sicknesses for the diagnosis and um this is actually showing that the diagnosis, let's see. Yeah, this diagnosis is showing that it was for an injury.
[AGENT][NEGATIVE] Which is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] So the S 93401A. I'll see if uh I can send it back to coding and on the other one tonight for the same reason.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEGATIVE] Yes, sir. I denied for the same reason.
[CUSTOMER][NEUTRAL] OK, and do you have a claim number for the $84.01?
[AGENT][NEUTRAL] Yeah, the claim number for that one is 3,602,020.
[CUSTOMER][NEUTRAL] Thank you, uh, reference number for the call?
[AGENT][NEUTRAL] For the reference number, you can use my name and today's date. My name is [PII], um it's spelled [PII] Last initial is [PII], and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, that was it. Thank you very much and you have a great day.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL. Mm bye.
[CUSTOMER][NEUTRAL] Bye bye.