AccountId: 011433970860
ContactId: 76177704-1572-4ee2-960c-5e0cc68d4aaa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 461660 ms
Total Talk Time (AGENT): 143850 ms
Total Talk Time (CUSTOMER): 137733 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/76177704-1572-4ee2-960c-5e0cc68d4aaa_20250107T16:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, hey, this is [PII] and. I'm calling from provider's office in a Pin County Medical Center, and I'm looking for claim status.
[AGENT][NEUTRAL] OK, I didn't understand your name. Can you spell it for me, please?
[CUSTOMER][NEUTRAL] Yeah, sure. It's [PII].
[AGENT][NEUTRAL] [PII], OK and you said you're checking claim status?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. What's the policy number?
[CUSTOMER][NEUTRAL] Yeah, just a moment. Let me just pull up it. And it would be D as in Delta 41203179.
[AGENT][NEUTRAL] OK, do you have a copy of the medical ID card? The APL number starts with a 0.
[CUSTOMER][NEGATIVE] Mm, unfortunately, we do not have that.
[AGENT][NEUTRAL] Can you spell the patient's first and last name please?
[CUSTOMER][NEUTRAL] Sure. The patient full name would be um [PII] Burger. First name would be [PII], and last name of the patient would be [PII] [PII].
[AGENT][POSITIVE] Thank you. What's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and this is the direct line no extension.
[AGENT][NEUTRAL] OK, you gave me [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][POSITIVE] Yeah, no problem. Take your time.
[AGENT][NEUTRAL] And what state does [PII] reside?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Where does [PII] live? What state?
[CUSTOMER][NEUTRAL] OK, for the like data service of the patient would be on [PII].
[AGENT][NEUTRAL] I'm trying to confirm the address. What state does the patient live?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK. The state would be [PII] and the address of the patient, like you want the full address?
[AGENT][NEUTRAL] If you have it, please.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] And what's the date of birth?
[CUSTOMER][NEUTRAL] And date of birth would be [PII].
[AGENT][NEUTRAL] Are you a dental or medical provider, Will?
[CUSTOMER][NEUTRAL] Uh, like it's medical provider.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said Will's date of birth is [PII]?
[AGENT][NEUTRAL] Can you verify the date of birth for me, please?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you state that you're checking a claim status we can provide that information. Can you provide the date of service and charge?
[CUSTOMER][NEUTRAL] Sure, data service was for [PII] with the total charges of $192.
[AGENT][NEUTRAL] 192 and you said date of service is [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, so the claim was received, uh, [PII].
[AGENT][NEGATIVE] Processed on [PII] and no payment was made. Outpatient facility is not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEGATIVE] OK. The, uh, it was, uh, denied for
[CUSTOMER][NEUTRAL] We are out of network, right?
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Out of network, uh, facility not covered, right?
[AGENT][NEUTRAL] Uh, no, outpatient services are not covered.
[AGENT][NEUTRAL] Outpatient hospital is not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK, outpatient services are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Services. OK, thank you so much. And uh when this claim was made, could, do you have any date of like uh date?
[AGENT][NEUTRAL] The date that it was processed, which was [PII], and will you can also check your status online at [PII] and did you have any other questions?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, I'm just, I'm looking for the claim number, please.
[AGENT][NEUTRAL] That number is 353-560-9.
[CUSTOMER][NEUTRAL] 5.
[CUSTOMER][NEUTRAL] 353
[AGENT][NEUTRAL] 5609.
[CUSTOMER][NEUTRAL] 09. Thank you so much. And unfortunately we did not receive any explanation of benefits from the insurance. I would really appreciate if you can provide me the explanation of benefit via fax.
[AGENT][NEUTRAL] Yeah, so it was mailed the next business day which would have been [PII] and it's available now online I could assist you creating an account to download a copy of the explanation of benefits. Let me know when you're ready for the address.
[CUSTOMER][POSITIVE] Uh, yeah, I would really appreciate if you can help me with that.
[AGENT][NEUTRAL] The address is secured. That's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, I see.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK. It's secure.
[AGENT][NEUTRAL] With a D on the end secured.
[CUSTOMER][NEUTRAL] Actually cutting in and out.
[CUSTOMER][POSITIVE] Secure.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, tell me what you have and then I'll correct it if it's incorrect.
[CUSTOMER][POSITIVE] Actually, uh, your voice is cutting, so I do not have anything. It's, it's secure.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] You
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII],
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] See.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] COL.