AccountId: 011433970860
ContactId: 5a865ca7-d111-4287-a46f-0e61848fc859
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 562659 ms
Total Talk Time (AGENT): 132687 ms
Total Talk Time (CUSTOMER): 172622 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/5a865ca7-d111-4287-a46f-0e61848fc859_20250404T19:12_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII]. I'm calling from the provider's office to check on the claim status.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, [PII], I can help you with uh claim status. Do you have the member ID?
[CUSTOMER][NEUTRAL] Yes, it is D as in Delta 473051.
[CUSTOMER][NEUTRAL] Sorry, 05915.
[AGENT][NEUTRAL] And do you have the last name of the patient?
[CUSTOMER][NEUTRAL] Yes. Last name is [PII].
[CUSTOMER][NEUTRAL] Spells like [PII] Umbrella [PII].
[AGENT][NEUTRAL] OK, that was [PII]. What was the rest of it?
[CUSTOMER][NEUTRAL] Uh, [PII]
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] No, hold on.
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, what, uh, do you have the birth date?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] And do you have a good callback number, [PII]?
[CUSTOMER][NEUTRAL] Yes, yes. It is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] What was the date of service?
[CUSTOMER][NEUTRAL] Detect services. [PII]. And the bill amount is $670 even.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, so.
[CUSTOMER][NEGATIVE] Oh no let me.
[AGENT][NEUTRAL] Um, this is a not a covered service under the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it is denied as a non-covered service?
[AGENT][NEUTRAL] Yes, and it was received on
[AGENT][NEUTRAL] [PII] process 110 [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Mm, may I know when it got denied?
[AGENT][NEUTRAL] Oh, it was denied on [PII].
[CUSTOMER][NEUTRAL] OK. And may I know um it is not covered under the patient plan or the provider plan?
[AGENT][NEUTRAL] Yes, it's not a covered benefit. Inpatient doctors visits are not covered under the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Um, so may I know whether how much uh the patient responsibility is?
[AGENT][NEUTRAL] Um, this is a secondary policy. We do not determine patient responsibility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] So, may I get the claim number?
[AGENT][NEUTRAL] The claim number is 355-0411.
[CUSTOMER][NEUTRAL] Thank you. So could you please send me a copy of PROP?
[AGENT][NEUTRAL] Yes, what's your fax?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'll get that faxed over. It just takes about 5 minutes.
[AGENT][NEUTRAL] Is there anything else I can help with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yes, I do have 2 more claims, the same patient.
[CUSTOMER][NEUTRAL] Could you please help me with that too?
[AGENT][NEUTRAL] OK, what's the date of service?
[CUSTOMER][NEUTRAL] Um, just a moment. Before that, may I get the call reference number?
[AGENT][NEUTRAL] It's my first name, [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then first initial to last name is [PII] and today's date.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Mhm, yes, thank you.
[CUSTOMER][NEUTRAL] Um, yeah, the next date of services [PII]. And the bill amount is $476 even.
[CUSTOMER][NEUTRAL] This is
[AGENT][NEUTRAL] And what was the bill amount?
[CUSTOMER][NEUTRAL] 476.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Uh, that one was denied for the same reason. The policy does not have benefits for doctor inpatient visits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, OK. I got it.
[CUSTOMER][NEUTRAL] So, could you please send me a copy of EUB for this one too?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Thank you, yeah, may I get the claim number?
[AGENT][NEUTRAL] Claim number is 355-0408.
[CUSTOMER][POSITIVE] Yes, thank you.
[CUSTOMER][NEUTRAL] And also make the uh received date and the process date for this month.
[AGENT][NEUTRAL] Yeah, that one is.
[AGENT][NEUTRAL] It was received on [PII] and then processed [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh sorry, could you please repeat the date once again.
[AGENT][NEUTRAL] Um, it was.
[AGENT][NEUTRAL] Oh, OK, actually this is, it was received [PII].
[AGENT][NEUTRAL] Processed on [PII].
[CUSTOMER][POSITIVE] Mhm thank you.
[CUSTOMER][NEUTRAL] Um, yeah. So shall I say the next date of service?
[AGENT][NEUTRAL] Uh, yes, give me just a moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, what's the next date of service?
[CUSTOMER][NEUTRAL] Um, it is [PII], and the billing amount is $335 even.
[AGENT][NEUTRAL] Uh, that one was received [PII], denied on [PII], inpatient doctor visits not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Thank you. You have me get the claim number?
[AGENT][NEUTRAL] Uh, claim number is 355-0403.
[CUSTOMER][POSITIVE] Yes, thank you. Thank you so much for assisting, [PII].
[CUSTOMER][POSITIVE] Have a good day.
[AGENT][POSITIVE] OK, anything else? OK, thank you so much for calling APL.
[CUSTOMER][NEUTRAL] Nope, that's it.
[AGENT][POSITIVE] Have a good day.
[CUSTOMER][POSITIVE] Mhm thank you. Have a good day bye bye.