AccountId: 011433970860
ContactId: 5d75974c-4d24-4fec-9ae8-496d0323c32d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 811280 ms
Total Talk Time (AGENT): 196837 ms
Total Talk Time (CUSTOMER): 220268 ms
Interruptions: 1
Overall Sentiment: AGENT=2.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/5d75974c-4d24-4fec-9ae8-496d0323c32d_20250507T15:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII], and I'm calling for claim status.
[AGENT][NEUTRAL] OK, Ms. [PII], I can help you with the claim status. May I please get your callback number?
[CUSTOMER][NEUTRAL] Um, yeah, sure, it's [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK. Patient's name is [PII]. Date of birth is [PII]. And policy number is 02024680 M for [PII], L for Lima, number 8.
[AGENT][POSITIVE] OK, thank you so much let me look at that up.
[CUSTOMER][NEUTRAL] Mhm sure.
[AGENT][NEUTRAL] Thank you and then what is [PII]'s data service and charge amount?
[CUSTOMER][NEUTRAL] OK, it's [PII] 2024 $200 even.
[AGENT][NEUTRAL] OK and then what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] $35.
[CUSTOMER][NEUTRAL] Even
[AGENT][NEUTRAL] OK, thank you. And then can you please give me the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Yeah, sure, um, Doctor [PII] from Valencia Medical Center.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold, Miss [PII], while I look up this claim for us and I'll be right back.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 35
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, Ms. [PII]. I've got the claim pulled up, um, but first let me give you the good policy number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, the one that
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] We had previously has been uh lapsed, but this is a good active one. It's 217-5427.
[AGENT][NEUTRAL] And the claim is, the number is 359-755-4.
[AGENT][NEUTRAL] And the claim was denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Mm, OK, let me document that.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Mm mm.
[CUSTOMER][POSITIVE] OK, got it, thank you so much.
[CUSTOMER][NEUTRAL] All right, just to confirm, um, the, the new policy is 2175427.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, perfect. Alright, thank you so much. Uh, let me ask you something. I have um two other claims here from the same facility, just different patients, but I'm not um sure if you can help me with that.
[AGENT][NEUTRAL] Absolutely. Can you give me um the next patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK, sure, um, before that, is there any re co reference number for this one?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name [PII] and today's date on all of them.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, got it, thank you so much. OK, so next, uh.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Mhm did you said members ID?
[AGENT][NEUTRAL] Uh, member ID, yes, and name and date of birth.
[CUSTOMER][NEUTRAL] For the next patient?
[CUSTOMER][NEUTRAL] OK, sure. OK, first member's ID, the one that I got here is 01407264 M for Mary, L for Lima number 8.
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, let me look this one up real quick.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And what is [PII]'s data service?
[CUSTOMER][NEUTRAL] OK. It's um 214-2025, total charges 200 and after the primer's insurance, let me check for that.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm mm mm, just one quick second here.
[AGENT][POSITIVE] Yes, ma'am. Take your time.
[CUSTOMER][NEUTRAL] Mm mm mm 0 25.
[CUSTOMER][POSITIVE] Mm thank you. uh OK, I got it $25 even.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold and you said it was also for [PII], is that correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, yeah, same, same provider.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes ma'am, it's gonna be a brief hold. I'm gonna look this one up and I'll be right back with you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Right
[AGENT][POSITIVE] Wow.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK Miss [PII], I have this claim ready for you.
[AGENT][NEUTRAL] The claim number is 3597487 and it was also denied for the same reason that the um insured's policy does not cover office visits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, OK, got it.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] OK, thank you so much uh got it.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Alright, and I got here the last um the last claim.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so members ID for this one is 02450266.
[CUSTOMER][NEUTRAL] Member's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, let me look up Miss [PII] real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then what is, uh, Zoe's data service and charge amount?
[CUSTOMER][NEUTRAL] OK, sure. date of service is [PII]. Charge amount total is $295 after premium insurance is um $35 even.
[AGENT][NEUTRAL] OK. All right, a brief hold again. I'll be right back with you, Miss [PII].
[CUSTOMER][POSITIVE] Mhm mhm sure thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much Ms. [PII] for holding for me. This one has a different policy number also. Let me give you the good policy number it's 2,592,520.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this claim number is
[AGENT][NEUTRAL] 3597463 and it was also denied for the same reason office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][POSITIVE] All right, got it, thank you so much. I think that will be, that will be all. Thank you so much for your help. I really appreciate it.
[AGENT][POSITIVE] Well, you're very welcome, Ms. [PII], and I hope you have a wonderful rest of your week and thank you for calling APL.
[CUSTOMER][POSITIVE] You too thank you bye bye have a great day.
[AGENT][POSITIVE] You're welcome. Bye-bye, ma'am. You too. Thank you.