AccountId: 011433970860
ContactId: 80acccdc-373d-491d-a316-bbfc8aa48a05
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 377880 ms
Total Talk Time (AGENT): 101540 ms
Total Talk Time (CUSTOMER): 143714 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/80acccdc-373d-491d-a316-bbfc8aa48a05_20250402T18:38_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 for the provider to check in additional information about the claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes, [PII].
[AGENT][NEUTRAL] OK, I'm happy to check on a claim for you today, [PII]. What's the patient's policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yes, uh, the patient's policy number for this one, it shows 018885558.
[AGENT][POSITIVE] Thank you, [PII]. And do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, [PII] and it is a direct line.
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Patient's name, it is?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that. And then what's the date of service?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Date of service, [PII] with the bill amount $100 even.
[AGENT][POSITIVE] All right. Thank you. One moment.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Billed them out with $100 correct?
[CUSTOMER][NEUTRAL] Um, just one thing and I make sure that.
[CUSTOMER][NEUTRAL] The the moon.
[CUSTOMER][NEUTRAL] No, it's not $100. It is
[CUSTOMER][NEUTRAL] $1,993 even. $1,993.62.
[AGENT][NEUTRAL] Date of service, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, we have one claim on file for this state of service. The claim was received on [PII]. Claim was denied. Services not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK. Under the patient's plan, right, or providers contact or pay guidelines, it's consider which one?
[AGENT][NEUTRAL] Under the patient plan.
[CUSTOMER][NEUTRAL] May I know the patient's plan name?
[AGENT][NEUTRAL] Uh, we are the secondary, uh, insurance. This is a Medlink plan.
[CUSTOMER][NEUTRAL] OK. So the claim number, it is ends with 3543. I'm right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, OK. So, when the claim got delayed on [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and so for this one.
[CUSTOMER][NEUTRAL] Just one second. May I know who is responsible for this service, either the patient or provider?
[AGENT][NEUTRAL] We're not able to advise on patient responsibility, that would be up to the facility or the provider.
[CUSTOMER][POSITIVE] OK, thank you so much. Can I get the call reference number for this claim?
[AGENT][NEUTRAL] Call reference would be my name with my last initials and today's date. My name again is [PII].
[AGENT][NEUTRAL] [PII] Last initial is [PII].
[CUSTOMER][NEUTRAL] OK. [PII], right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK, so for this.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] Can you go to the next number? I have one more number.
[AGENT][NEUTRAL] Yeah, what's the next policy number?
[CUSTOMER][NEUTRAL] 0131918.
[AGENT][NEUTRAL] 031918.
[CUSTOMER][NEUTRAL] No, 01631918.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name, it is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Data service
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] With the bill amount that is.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] A t-shirts, $367.50 50.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] 02 059999
[AGENT][NEGATIVE] We did receive a claim for the state of service. Claim was received on [PII]. Claim was denied. Uh, looks like kinesinology, speech, or occupational therapy are not covered under the patient plan.
[CUSTOMER][NEUTRAL] OK. So for this 1 may I know the patient's planning?
[AGENT][NEUTRAL] Uh, we are the secondary insurance. This is a Medlink plan.
[CUSTOMER][POSITIVE] OK. Thank you so much for that one. So,
[CUSTOMER][POSITIVE] Could you able to provide me the uh it's the same one. Thank you so much for call reference number. Thank you so much for assisting those two claims, [PII]. Have a wonderful day.
[AGENT][NEUTRAL] YouTubers. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.