AccountId: 011433970860
ContactId: 87f9cd33-3957-494b-a7e2-92a16531f6e5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 415630 ms
Total Talk Time (AGENT): 81472 ms
Total Talk Time (CUSTOMER): 109143 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/87f9cd33-3957-494b-a7e2-92a16531f6e5_20250604T16:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL this is [PII].
[AGENT][NEUTRAL] How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling for a provider to check on additional information about the claim that has been denied. Please note that this call will be monitored and recorded for quality and training purposes. How are you doing today?
[AGENT][POSITIVE] I'm doing good [PII] and I can help you with your claim information sir. Will you please give me your call back number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Yes, uh, before that, I would like to inform you that your internet connection is not that good. You keep breaking up.
[CUSTOMER][NEUTRAL] number
[AGENT][POSITIVE] OK thank you
[AGENT][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then um what is your callback number?
[CUSTOMER][NEUTRAL] And uh how that number?
[CUSTOMER][NEUTRAL] Yes, callback number is [PII]. It's a direct line or extension.
[AGENT][NEUTRAL] Thank you. And then what is the member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Member's name is [PII]. Date of birth, [PII].
[CUSTOMER][NEUTRAL] Member ID is 01611733 M as in Mike, [PII] as in [PII].
[AGENT][NEUTRAL] OK, let me pull up that policy real quick.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh yeah I love it.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, and then what is the date of service please?
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] That would be [PII].
[AGENT][NEUTRAL] And the charge of account?
[CUSTOMER][NEUTRAL] $276 even.
[AGENT][NEUTRAL] And then what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Um, right.
[CUSTOMER][NEUTRAL] So the primary, I.
[CUSTOMER][NEUTRAL] So primary paid $62.55. So you minus that is 26 $276 that the
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][POSITIVE] Yes, sir. Take your time.
[CUSTOMER][NEUTRAL] So, uh, the total charge is $276 and primary pays $62.55. Balance would be $213.45.
[AGENT][NEUTRAL] Thank you, sir. And um what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] facility name is Norma Rosh NDPA.
[AGENT][NEUTRAL] OK, and then you said it was already denied. Can you please give me the claim number?
[CUSTOMER][NEUTRAL] Claim number is 3600923.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim for us and I'll be right back, sir.
[CUSTOMER][POSITIVE] Sure. Take care now.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] At that right.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, thank you for holding for me, [PII]. I have the claim information for you.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] On your claim number 3600923, the claim has been denied because under the patient's plan office visits are not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. Uh, may I know what is the patient plan name?
[AGENT][NEUTRAL] Medlink
[CUSTOMER][NEUTRAL] Metlink is that?
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] OK. And uh may I know the call reference number?
[AGENT][NEUTRAL] Yes sir, you can use my name [PII] today's date.
[CUSTOMER][POSITIVE] Thank you so much for, for assisting me. You have a wonderful day.
[AGENT][POSITIVE] You're very welcome you have a wonderful day too, [PII]. Thank you for calling APL.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. Bye-bye, sir.