AccountId: 011433970860
ContactId: 87a839ec-da37-4500-9f45-404dfac1c3d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 929609 ms
Total Talk Time (AGENT): 157862 ms
Total Talk Time (CUSTOMER): 174309 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/87a839ec-da37-4500-9f45-404dfac1c3d3_20250618T13:36_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], good morning. This is [PII] calling from doctor office. I want to check claim status.
[AGENT][NEUTRAL] I can help you with claim status. [PII]. Can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, callback number is [PII].
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] All right. It's 1353178 M like Mary, L like Lima, number 8.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] Oh yeah, just a moment.
[CUSTOMER][NEUTRAL] Occupation full name is uh [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] And do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] Oh yeah, just a moment.
[CUSTOMER][NEUTRAL] Wait a second.
[CUSTOMER][NEUTRAL] Alright ma'am data service is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is the total bill amount?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The amount is $4,348.12.
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] And what is the provider's name?
[CUSTOMER][NEUTRAL] 710.
[CUSTOMER][NEUTRAL] Group name is him on call.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like we received this claim on [PII]. It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 35.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] 72029.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it looks like this claim was denied because the service is not covered when performed in a doctor's office or a clinic.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEGATIVE] But he said this is not good when performed in the office or clinic, right?
[AGENT][NEUTRAL] It's not covered when it's performed in a doctor's office or a clinic.
[CUSTOMER][NEUTRAL] OK. And uh, this, is there like a, uh, plan, like,
[CUSTOMER][NEUTRAL] The special insurances.
[CUSTOMER][NEGATIVE] Because, uh, American public life is not, uh, like paying us the offices as well as.
[CUSTOMER][NEUTRAL] The other courts
[CUSTOMER][NEUTRAL] Like an infusion course. So I want to know what.
[CUSTOMER][NEUTRAL] This benefit for specific benefit allowed.
[CUSTOMER][NEUTRAL] All the coverage.
[AGENT][NEUTRAL] It would need to be in an outpatient service.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] It would need to be in an outpatient facility, not a doctor's office.
[AGENT][NEUTRAL] Or a clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And, uh, could you fax us the, uh, the IDOB?
[AGENT][NEUTRAL] Give me just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And would you like the attention to go to you?
[CUSTOMER][NEUTRAL] Yes, [PII]. Last initial [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what is the fax number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Fax number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] No. Uh [PII].
[AGENT][NEUTRAL] [PII]. OK, give me just one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Alright I just sent that fax over.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] And, uh, for the same patient, I have one more service to check and, uh, next one more patient single claim, I mean two claims more. For this one, could you provide me a reference number and your last initial, please?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name and last initial and today's date, so [PII] and then today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hold just a moment.
[CUSTOMER][NEUTRAL] Uh, can I provide you next to the service?
[CUSTOMER][NEUTRAL] Salvation.
[AGENT][POSITIVE] The next day of service, yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] $4,348.12.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, it looks like we received this claim on [PII].
[AGENT][NEUTRAL] [PII]. It was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim was denied for the same reason that the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Ma'am, uh, fax the OP please.
[CUSTOMER][NEUTRAL] And uh could you verify the fax number please?
[AGENT][NEUTRAL] Um, our fax number?
[CUSTOMER][NEUTRAL] Or fax number. Could you verify please?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] I have [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, right. And ma'am, uh, once you check from your site, uh, how much time it will take to receive?
[AGENT][POSITIVE] I could take anywhere from a couple of minutes to an hour.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] It looks like it was just sent to you.
[AGENT][NEUTRAL] The first one.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Give me just a moment while I send this one out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. OK.
[AGENT][NEUTRAL] Alright, I just sent the 2nd 1 out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I move to the next question.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, give me just one moment to close out this patient.
[CUSTOMER][NEUTRAL] Is the account number is uh.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And what is the next policy number?
[CUSTOMER][NEUTRAL] OK. 02308242 ML 8.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] Yeah, patient full name is uh [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] And what is the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] No [PII].
[AGENT][POSITIVE] OK, I'm so sorry.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] And what's the total bill amount?
[CUSTOMER][NEUTRAL] $410.28.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] It looks like we received this claim on [PII]. It was processed on [PII].
[AGENT][NEUTRAL] The claim number is 35873007.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this claim was denied due to office visits not being covered.
[CUSTOMER][NEUTRAL] If it's it's not.
[CUSTOMER][NEUTRAL] All right, ma'am, uh, fix this will be also.
[AGENT][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] Alright I just sent that fax over.
[CUSTOMER][NEUTRAL] All right, ma'am.
[CUSTOMER][POSITIVE] OK. Thank you for wonderful cooperation. Enjoy the rest of the day.
[AGENT][POSITIVE] Is there anything else I can help you with? Thank you for calling APL and I hope you have a great day.
[CUSTOMER][POSITIVE] Take care.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Bye.