AccountId: 011433970860
ContactId: 65193883-97bc-4ecd-ae84-3a0f07efdc6f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 405149 ms
Total Talk Time (AGENT): 98420 ms
Total Talk Time (CUSTOMER): 138561 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/65193883-97bc-4ecd-ae84-3a0f07efdc6f_20250520T13:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII]. I'm calling from office looking for a claim status.
[AGENT][NEUTRAL] I can help you with claim status. Can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] I can
[CUSTOMER][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Yeah. It's [PII].
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] Policy number is going to be
[CUSTOMER][NEUTRAL] 02592452
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] Can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Can I get the name
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] And do you have the date of service or the claim number?
[CUSTOMER][NEUTRAL] Data service I have data services 112025 with the amount of $195 even.
[AGENT][NEUTRAL] OK, one moment while I look for that.
[CUSTOMER][NEUTRAL] OK one moment
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you need the claim number?
[CUSTOMER][NEUTRAL] You need the number? Yes, please.
[AGENT][NEUTRAL] OK, it's 3599.
[CUSTOMER][NEUTRAL] 35
[CUSTOMER][NEUTRAL] 99
[AGENT][NEUTRAL] 073.
[CUSTOMER][NEUTRAL] 73.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] It looks like
[CUSTOMER][NEUTRAL] It looks like
[AGENT][NEUTRAL] The insured sent that claim in on the [PII].
[CUSTOMER][NEUTRAL] The insured.
[CUSTOMER][NEUTRAL] Since that on the [PII].
[AGENT][NEUTRAL] It was processed on the [PII].
[CUSTOMER][NEUTRAL] It was like.
[AGENT][NEGATIVE] And it was denied.
[CUSTOMER][NEUTRAL] And it was
[CUSTOMER][NEUTRAL] And what is the denial reason?
[AGENT][NEUTRAL] Um, office visits aren't covered by this policy.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh, OK, just a second.
[CUSTOMER][NEUTRAL] Office visit is not covered as per patient policy, right?
[AGENT][POSITIVE] Correct, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh how much is the patient's responsibility?
[AGENT][NEUTRAL] I, I would not know that they submitted this claim. It depends on what the provider charged them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, but, uh, is there any allowed amount which is applied to a patient responsibility?
[AGENT][NEUTRAL] Um, no, because this service isn't covered under their policy. I imagine it would be the full amount.
[CUSTOMER][NEGATIVE] Oh no,
[CUSTOMER][NEUTRAL] Pro
[CUSTOMER][NEUTRAL] The policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] OK. And uh can you please tell me which policy patient have?
[AGENT][NEUTRAL] It's a meddling policy, so it's a secondary gap policy.
[CUSTOMER][NEUTRAL] like a
[CUSTOMER][NEUTRAL] And can you please send me the copy of your via fax?
[AGENT][NEUTRAL] Our fax is [PII].
[CUSTOMER][NEUTRAL] No, I'm asking, can you, can, can you please send me the UB copy via fax?
[AGENT][NEUTRAL] 3650.
[AGENT][NEUTRAL] Oh, you need a copy of it?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] What's the provider name?
[CUSTOMER][NEUTRAL] Graves Gilbert Clinic.
[CUSTOMER][NEUTRAL] I have fax number for you.
[AGENT][NEUTRAL] OK, what's the fax number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull that up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK. And then how much time we can receive the UB?
[AGENT][NEUTRAL] Um, you can expect it within 48 hours.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Oh, OK. Can I get the call reference number, please?
[AGENT][NEUTRAL] We don't have call reference numbers but you can use my name in today's date, so [PII].
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] number
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] The letter H as in hospital.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Water is in hospital.
[AGENT][NEUTRAL] In today's
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK. Thank you so much for your help, [PII]. Have a nice day. Bye-bye.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.