AccountId: 011433970860
ContactId: 5fd5b167-e3d0-4332-8093-f64caa4d9cf3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 268429 ms
Total Talk Time (AGENT): 56964 ms
Total Talk Time (CUSTOMER): 84241 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/5fd5b167-e3d0-4332-8093-f64caa4d9cf3_20250605T14:36_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] speaking. I wanted to check the claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status, fraud. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It's [PII] and my name spells like [PII]. It's [PII].
[AGENT][NEUTRAL] OK, right.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] You have the policy number for the patient?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's 02007928.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Scandal [PII].
[CUSTOMER][NEUTRAL] And over this
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And date of service and bill charges?
[CUSTOMER][NEUTRAL] Data service [PII] with the bill amount $229 even.
[AGENT][NEUTRAL] You say [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] We received a claim on 33-2025.
[AGENT][NEUTRAL] It was processed 36.
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Wait, wait, wait.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes, please repeat that.
[AGENT][NEUTRAL] Claim was received on [PII].
[AGENT][NEUTRAL] Process 36 2025.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] And then it was denied as office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] So it's from patient side, right?
[CUSTOMER][NEUTRAL] 212.
[AGENT][NEUTRAL] The the policy doesn't cover office visits.
[CUSTOMER][NEUTRAL] OK. So in this, for this CPT code, it was first processed by UHC.
[CUSTOMER][NEUTRAL] And then then it was billed to.
[CUSTOMER][NEUTRAL] Secondary
[AGENT][NEUTRAL] Right, and this policy doesn't cover office visits.
[CUSTOMER][NEUTRAL] Did you
[CUSTOMER][NEUTRAL] OK. So the remaining amount for $100 we can build towards patient responsibility.
[AGENT][NEUTRAL] We are a secondary, we're a secondary policy, so we can't determine patient responsibility.
[CUSTOMER][NEUTRAL] To the patient.
[CUSTOMER][NEUTRAL] OK. Does the patient have any tertiary insurance?
[AGENT][NEUTRAL] Uh, I don't show any, no.
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] Would you please verify the claim number?
[AGENT][NEUTRAL] Claim number 3572439.
[CUSTOMER][NEUTRAL] 3572439. OK. And also, how do you spell your name?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] So my name is [PII]
[CUSTOMER][NEUTRAL] OK, and what would be the call reference number?
[AGENT][NEUTRAL] It's my name and today's date.
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so much. That's it for today. Have a wonderful day.
[AGENT][POSITIVE] Thank you for calling APL. You have a great day too. Bye bye.