AccountId: 011433970860
ContactId: 63bb51a4-2a11-48e8-8308-d799eb2582ac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 570320 ms
Total Talk Time (AGENT): 121692 ms
Total Talk Time (CUSTOMER): 109489 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/63bb51a4-2a11-48e8-8308-d799eb2582ac_20250226T21:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][POSITIVE] Thank you for calling HL [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hi.
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. I'm calling from provider's office looking for a claim. Can you please spell your name?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yes, it's [PII] And can you spell yours also?
[CUSTOMER][NEUTRAL] [PII] And uh I just wanna know the, your last name initial as well.
[AGENT][NEUTRAL] A
[CUSTOMER][POSITIVE] OK, thank you. I'm here to get the clear status.
[AGENT][NEUTRAL] OK, and [PII].
[AGENT][NEUTRAL] OK, uh, [PII], can I'll help you with claim status. Can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yes, callback number is [PII].
[CUSTOMER][NEUTRAL] Oh, sorry. [PII].
[AGENT][POSITIVE] OK, thank you so much. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah. One moment, please.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] The patient name is uh
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK. And the policy number, please?
[CUSTOMER][NEUTRAL] Yeah, the policy number is
[CUSTOMER][NEUTRAL] 02221951.
[AGENT][NEUTRAL] OK, let me pull up that policy.
[AGENT][NEUTRAL] OK. And then what is the date of service for [PII] and the charge amount?
[CUSTOMER][NEUTRAL] Yes, the date of service is [PII] and the charge amount is uh
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] $250 even.
[AGENT][NEUTRAL] OK, and then what's the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] One moment I need to check.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, actually, the primary insurance left uh $250 even.
[AGENT][NEUTRAL] OK, and then what, what is the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, that is PSES Urgent Care.
[CUSTOMER][NEUTRAL] I can do for you?
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I pull up this claim for you and I will be right back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, thank you for holding for me, [PII]. So I have the claim for you. The claim number is 3552895. The claim was denied because we need the explanation of benefits showing that the primary insurance paid.
[CUSTOMER][NEUTRAL] The claim number, can you please repeat again? 355.
[AGENT][NEUTRAL] 3552895
[CUSTOMER][NEUTRAL] OK, claim is denied for prime OB, right?
[AGENT][NEUTRAL] We need, well, the benefits are payable only if the major medical insurance provider provides benefits. If the claim is later paid by your major medical insurance, please send the explanation of benefits showing the benefits were paid.
[CUSTOMER][NEUTRAL] OK. Can you please provide us a copy of UV?
[CUSTOMER][NEUTRAL] 10X.
[AGENT][NEUTRAL] Yes, what is your fax number?
[CUSTOMER][NEUTRAL] Yes, the fax number is [PII].
[AGENT][NEUTRAL] OK, and let me repeat it.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes, please repeat.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, I'm gonna put you on hold and I'm gonna get that fax ready for 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][POSITIVE] And thank you for holding for me. I have that fax on its way to you now.
[CUSTOMER][NEUTRAL] OK. Well, what's the on time? How much time it will take?
[AGENT][NEUTRAL] You just have to give it a chance to get to you. It's been sent.
[CUSTOMER][NEUTRAL] OK. What's the call reference number for today's call?
[AGENT][NEUTRAL] Uh, you can use my name [PII], and today's date.
[CUSTOMER][NEUTRAL] Sorry, and today's date, OK. Well, thank you, sorry.
[AGENT][POSITIVE] Thank you, you have a good day, [PII]. Thanks for calling APL.
[CUSTOMER][POSITIVE] Have a nice day bye bye.
[AGENT][NEUTRAL] Bye-bye.