AccountId: 011433970860
ContactId: 86404388-3f1f-4534-8172-eae889d3da43
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 395459 ms
Total Talk Time (AGENT): 82938 ms
Total Talk Time (CUSTOMER): 189128 ms
Interruptions: 4
Overall Sentiment: AGENT=0.2, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/86404388-3f1f-4534-8172-eae889d3da43_20250407T19:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from provider's office. Check the claim status.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hi. I'm sorry, our phone cut out for a minute. How can I help you today?
[CUSTOMER][NEUTRAL] What do
[CUSTOMER][NEUTRAL] Uh yes, my name is [PII]. I'm calling from the provider's office. Check the claim status.
[CUSTOMER][POSITIVE] Yeah I'll be eating a lot.
[AGENT][NEUTRAL] OK, I can help you with claim status. Can I please get your call.
[CUSTOMER][NEUTRAL] Uh, yes sir. The contact number is [PII]. Direct line no extension.
[AGENT][NEUTRAL] Our call is disconnected.
[AGENT][NEUTRAL] OK. Thank you. And what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Patient first name is [PII]. Last name is [PII], and its date of birth is [PII]. And then the member ID is [PII].
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then what is the data service and the charge amount?
[CUSTOMER][NEUTRAL] Um, 224 of 2025 and total charge amount is $432 432.
[AGENT][NEUTRAL] Thank you. And then what is the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] I did.
[CUSTOMER][NEUTRAL] Yes, the leftover is $30 even $30.
[AGENT][NEUTRAL] OK, and can you please give me the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] Yes, ma'am. I'm calling from the doctor's office name called the Community Medical Associate.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim, Ms. [PII], and I'll be right back, OK?
[CUSTOMER][NEUTRAL] Mhm, OK. You are on hold.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Right
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK [PII] I have the um claim for you.
[AGENT][NEUTRAL] The claim number is 357-585-4.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim was denied because offices are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK, uh, the office visit copay is not covered under the patient plan, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, but upon checking in our side, uh, we, we receive a UB from the provider side, but it's not indicated that the, the $30 is, uh, listed as a patient responsibility.
[CUSTOMER][NEUTRAL] It's not indicated as a patient responsibility like that.
[AGENT][NEUTRAL] We don't give patient responsibility because that's determined by the provider.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] it is
[CUSTOMER][NEUTRAL] Uh, in which means the UB does not, uh, indicate to the patient responsibility, right?
[AGENT][NEGATIVE] Right, we never give patient responsibility.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, but it under the patient plan, the office visit co-pay is not covered, correct?
[AGENT][NEUTRAL] Right under the patient's plan, office visits are not covered under the policy.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, um, may I know when the claim is denied?
[AGENT][NEUTRAL] It's on [PII].
[CUSTOMER][NEUTRAL] OK, uh, what type of plan the patient have, like, uh, plan name of the patient?
[AGENT][NEUTRAL] Medlink
[CUSTOMER][NEUTRAL] Mad
[CUSTOMER][NEUTRAL] OK, may I get the call number please.
[AGENT][NEUTRAL] Yes, you can use my name [PII] and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. Have a great day. Bye.
[AGENT][POSITIVE] Well, you're very welcome Miss [PII]. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh-huh, no thanks. Um, if, uh, OK, OK, I have one more question. If the provider again requests the copy of UB, whether the patient responses like the, uh, the non-covered under the patient responsibility or the patient responsibility was indicated in the.