AccountId: 011433970860
ContactId: 70895aaa-0c3a-4132-9e93-4cf76e9a724f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 263470 ms
Total Talk Time (AGENT): 88271 ms
Total Talk Time (CUSTOMER): 89701 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/05/70895aaa-0c3a-4132-9e93-4cf76e9a724f_20250605T13:50_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Oh yeah, this is [PII] calling from the provider office to check on the claim status.
[AGENT][NEUTRAL] OK, I can verify claim status for you. And [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] That is 019144.
[CUSTOMER][NEUTRAL] 05 M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah, it is [PII].
[AGENT][NEUTRAL] OK, thank you. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, and what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] That is [PII]. Total charge of $3,386 even.
[AGENT][NEUTRAL] OK, and what was the balance after primary?
[CUSTOMER][NEUTRAL] Hm, primly left the balance of $100.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, what's the name of the place of service?
[CUSTOMER][NEUTRAL] Uh, Memorial Sada Surgery Center West.
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] Uh, memorial, same day Surgery Center, West.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, I'm sure the claim was denied as policy provides no benefits for treatment of conditions other than for sickness and injury as defined by the policy.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] What does that mean? Can you simplify this to that for me?
[AGENT][NEUTRAL] That means uh services other than for a sickness or injury is not covered under the policy.
[CUSTOMER][NEUTRAL] Oh this is other than.
[CUSTOMER][NEUTRAL] Sickness and injury?
[AGENT][NEUTRAL] Correct, it's not covered.
[CUSTOMER][NEUTRAL] And what is the claim number?
[AGENT][NEUTRAL] 3604299
[CUSTOMER][NEUTRAL] And on which date the claim was denied?
[AGENT][NEUTRAL] Uh, the claim process on [PII].
[CUSTOMER][NEUTRAL] Uh, for this one, can you please fax to UB?
[AGENT][NEUTRAL] OK, what is the fax number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and that's [PII]?
[CUSTOMER][NEUTRAL] Oh yes.
[AGENT][NEUTRAL] OK. And Ms. [PII], is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Yeah, I just want to ask what type of plan does the patient have?
[AGENT][NEUTRAL] It's a secondary supplemental policy.
[CUSTOMER][NEUTRAL] Secondary supplemental policy.
[CUSTOMER][NEUTRAL] And uh the uh
[CUSTOMER][NEUTRAL] Charges which are left by the primary, are they the patient responsibility?
[AGENT][NEUTRAL] We can't give patient responsibility. We can only verify how we process the claim.
[CUSTOMER][NEUTRAL] OK. Thank you. May I have the call reference number?
[AGENT][NEUTRAL] Uh, if you like, you may use my name in today's date.
[CUSTOMER][NEUTRAL] May I have your name?
[AGENT][NEUTRAL] It's [PII] [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. Have a great day.
[AGENT][NEUTRAL] Bye.