AccountId: 011433970860
ContactId: 5d8e4070-44a6-443a-beef-c1b44965ebdd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 533099 ms
Total Talk Time (AGENT): 78449 ms
Total Talk Time (CUSTOMER): 71209 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=-2.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/5d8e4070-44a6-443a-beef-c1b44965ebdd_20250317T14:58_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from providers Of Story checking on a claim status.
[AGENT][NEUTRAL] OK Miss [PII] I can help you with claim status um can I please get your call back number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] History callback number is [PII] [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yes, policy number is 1941602. Member's name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] Thank you and let me pull that policy up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK and then can you please give me the data service and the charge amount?
[CUSTOMER][NEUTRAL] Yes, state of service is [PII] and the amount is $3,0045 even 3045.
[AGENT][NEUTRAL] OK, and then what's the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh yes, it is $304304.60.
[CUSTOMER][NEUTRAL] Are
[AGENT][NEUTRAL] OK, and can you please give me the name of the facility?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's gastrogalo anesthesia associates.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I look up this claim for you [PII] and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK [PII], I've got it pulled up for you. The claim number is 342.
[AGENT][NEUTRAL] 9264.
[AGENT][NEGATIVE] And claim was denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Because the maximum amount payable for this occurrence has been met, so per recurrence means treatment for the same date or related condition unless separated by a period of 90 days.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] So this, this uh type of.
[CUSTOMER][NEUTRAL] Can you please fax me the OB for this?
[AGENT][NEUTRAL] Yes, I can. What's your fax number?
[CUSTOMER][NEUTRAL] His fax number is [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I get that faxed to you. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.