AccountId: 011433970860
ContactId: 73026b9b-8eca-447e-94e2-ec27d80d8dd1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 365850 ms
Total Talk Time (AGENT): 98448 ms
Total Talk Time (CUSTOMER): 123986 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/73026b9b-8eca-447e-94e2-ec27d80d8dd1_20250320T19:45_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. My name is [PII]. I'm calling for Manson Medical Center to know some additional information about the claim.
[AGENT][NEUTRAL] OK sir, and you said your name was [PII]?
[CUSTOMER][NEUTRAL] Yes, right?
[AGENT][NEUTRAL] And what's the name of the um facility you're calling from again, sir?
[CUSTOMER][NEUTRAL] Oh yes, I'm sorry. It is Munson Medical Center.
[AGENT][NEUTRAL] Munson Medical Center. OK, thank you. And then may I get your callback number, sir, just in case the call gets
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] It's disconnected.
[CUSTOMER][NEUTRAL] Of course, my call back number is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, sir, and I can help you with the claim status. Can you please give me the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sure. Patient's policy number is 2, 02504451.
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the date of birth
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is [PII]. Uh, no, no, [PII], sorry.
[AGENT][NEUTRAL] Thank you, sir. Alright, let me pull up this policy real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I've got [PII] pulled up. Can you please give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Data services [PII]. The amount is $656 even.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim for you and I'll be right back.
[CUSTOMER][POSITIVE] Sure. Sure, thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. I've got the claim number for you. The claim number is 3571768, and the claim was denied because it's non-covered under the patient's policy.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Is it non-covered because of the diagnosis code we build or it just um services excluded by the policy? Why is it not covered?
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] It's not covered because it's not a covered service under the, the patient's policy.
[CUSTOMER][NEUTRAL] Then the whole balance can be billed to the patient, isn't it?
[AGENT][NEGATIVE] No, we can't give patient responsibility.
[CUSTOMER][NEUTRAL] But there was no discount applied um on this claim, isn't it? There was no uh providers discount provider.
[AGENT][NEUTRAL] Uh, that's determined by the provider.
[CUSTOMER][NEUTRAL] But you did not apply any uh contractual adjustment for the claim you receive, right? So there is no contract between APL and my provider. So there is no discount provided to, to my provider, not to the patient, to my provider from your side as a contracted rate, I mean.
[CUSTOMER][NEUTRAL] Like, like
[CUSTOMER][NEUTRAL] OK, then. No, OK, I will.
[AGENT][NEUTRAL] I don't have contract information. I don't have contract information between provider and our company. I just know that the claim was denied because it's not covered for the patient's policy.
[CUSTOMER][NEUTRAL] OK, but um if, if we have any specific um information for this to be considered as non-covered by the plan, it just excluded, like, right? So there is no much information about this you know.
[AGENT][NEUTRAL] Right, there's nothing else I can give it's just non-covered.
[CUSTOMER][POSITIVE] OK, then I will um contact the patient um to obtain the money for the service. Thank you so much, Do you again for your kind assistance.
[CUSTOMER][NEUTRAL] Uh, may I please know if we have any reference number for the call? Um, if we have any reference number for your?
[AGENT][POSITIVE] Oh, you're so very welcome.
[AGENT][POSITIVE] Yes sir, you can use
[AGENT][NEUTRAL] Yes, you can use my name [PII] and today's date.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] All right, thank you. Have a good day. Bye bye.
[AGENT][POSITIVE] You too [PII] you have a wonderful day and thanks for calling APL.
[AGENT][NEUTRAL] Bye-bye, sir.
[CUSTOMER][NEUTRAL] Bye.