AccountId: 011433970860
ContactId: 655b3210-d810-45ae-b25d-55c191f2ac80
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 434890 ms
Total Talk Time (AGENT): 157719 ms
Total Talk Time (CUSTOMER): 95637 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/655b3210-d810-45ae-b25d-55c191f2ac80_20250314T17:16_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling to follow up on a claim.
[AGENT][NEUTRAL] OK, I can verify claim status for you. And Ms. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] 02457148
[AGENT][NEUTRAL] OK, thank you, ma'am. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII], no extension.
[AGENT][NEUTRAL] OK, thank you. And Ms. [PII], you say you're calling for claim status?
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] This is for [PII] [PII].
[AGENT][NEUTRAL] OK. And what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] Um, that date of service was.
[CUSTOMER][NEUTRAL] Excuse me, [PII] to $53124 charge amount is $31,147 even.
[AGENT][NEUTRAL] OK, and do you have the balance after primary process the claim?
[CUSTOMER][NEGATIVE] Um, I did not pay anything.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] I assuming it's for facility charges, correct?
[CUSTOMER][NEUTRAL] It is.
[AGENT][NEUTRAL] Uh, let me see, well, I'm looking at the wrong person. Give me one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, give me one moment and while I'm looking up claim information just to let you know we do have an online service center where providers can check claim status as well as print out the EOB and that site is at [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, it looks like um
[AGENT][NEUTRAL] It's in a pending status. It's, well, wait a minute, let me double check. Looks like we probably received it. Give me one moment.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] OK. Well, I show the claim process as physiology, speech and occupational therapy is not covered under the policy.
[CUSTOMER][NEGATIVE] So it denied um.
[AGENT][NEGATIVE] The night it's not covered.
[AGENT][NEUTRAL] Um, let me see. Looks like, I was for, she had occupational therapy.
[AGENT][NEGATIVE] Which is not covered under the plan.
[CUSTOMER][NEUTRAL] OK, occupational therapy not covered.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Can you provide me that claim number received date and the denial date?
[AGENT][NEUTRAL] Uh, yes, ma'am. Uh, claim received [PII], processed on [PII].
[AGENT][NEUTRAL] And the claim number is 357-517-3.
[CUSTOMER][NEUTRAL] 357-517-3
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, can you provide me with the reference number and can you look at one more account for me?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. Um, however, you may use my name is [PII], and give me one quick moment to type in this note, Ms. [PII].
[CUSTOMER][NEUTRAL] OK, and you said your name is [PII]?
[AGENT][NEUTRAL] Yes, ma'am. [PII], last initial [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what is the next policy number?
[CUSTOMER][NEUTRAL] OK, next policy number.
[CUSTOMER][NEUTRAL] Oh gosh, where is it?
[CUSTOMER][NEUTRAL] OK, it's 025837887.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII] date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you, ma'am. And what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Data service, uh, let's see, [PII].
[CUSTOMER][NEUTRAL] Bill amount is $1,200,070.89.
[AGENT][NEUTRAL] Bless it, OK, give me one moment to see.
[AGENT][NEUTRAL] Uh, it looks like the claim process is outpatient services are not covered under the policy.
[AGENT][NEUTRAL] And this was
[AGENT][NEUTRAL] Uh, claim received [PII], processed on [PII].
[AGENT][NEUTRAL] And the claim number is 3555378.
[CUSTOMER][NEUTRAL] OK, you said outpatient services is not covered under the policy?
[AGENT][POSITIVE] Correct, yes, ma'am.
[CUSTOMER][NEUTRAL] So the responsibility is um the member's responsibility.
[AGENT][NEUTRAL] Uh, we can give patient responsibility. We can only verify how the claim was processed.
[CUSTOMER][NEUTRAL] The charges
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for your help and you did say the reference number is just your name, correct?
[AGENT][NEUTRAL] Uh, my name is today's date, yes, ma'am.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] Alright, you're welcome. Thank you for calling APL, Ms. [PII]. Have a great day and weekend.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][NEUTRAL] Bye.