AccountId: 011433970860
ContactId: 65041ead-34cb-44e9-b16d-100447846a0d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 187160 ms
Total Talk Time (AGENT): 77850 ms
Total Talk Time (CUSTOMER): 72500 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/65041ead-34cb-44e9-b16d-100447846a0d_20250204T21:03_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public. This is. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi. I am calling from Doctor [PII]'s office. I'm calling to follow up on a denial that I have received, please.
[AGENT][NEUTRAL] OK, I can help you with that. Can I get your name and a callback number?
[CUSTOMER][NEUTRAL] Sure. My name is [PII] and it's [PII].
[AGENT][NEUTRAL] Thank you and the policy number you're calling on?
[CUSTOMER][NEUTRAL] Policy number 02403459.
[CUSTOMER][NEUTRAL] What was your name?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] Thanks [PII].
[AGENT][NEUTRAL] No problem. And the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Uh, [PII] and it's [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying the policy and you did say, did you say you were calling for status or benefits?
[CUSTOMER][NEGATIVE] Well, no, um, uh, the status of this claim is denied. I just need further clarification towards the denial.
[AGENT][NEUTRAL] OK, and what is the date of service?
[CUSTOMER][NEUTRAL] Data service is [PII].
[CUSTOMER][NEUTRAL] For $2,394.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see, I do show the claim, so the physician office visit is not a covered service.
[AGENT][NEUTRAL] Um, I'm sorry, procedure 80307. It looks like that procedure was denied stating it was not covered by the primary and then the procedure 72052 was denied paid in full by the primary.
[CUSTOMER][NEUTRAL] Wait, so you're saying, let me see something.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I don't pay it in full by primer, then this one you say?
[CUSTOMER][NEGATIVE] 880207 is not covered because it's not paid by United and you're right.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] They requested, they requested documentation, so we're waiting on that.
[AGENT][NEUTRAL] OK, so if, if they process that procedure, apply it to patients, deductible, co-pay or co-insurance, we can re reconsider the charges.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, great. [PII], may I please have a reference number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] To reference our call, you will use my name and today's date. And is there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] No, ma'am. That's about it. Thank you so much for your help today.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome. You have a wonderful day. Thank you for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.