AccountId: 011433970860
ContactId: 8da45c74-476f-4860-bb03-c56b1c110d32
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 283059 ms
Total Talk Time (AGENT): 128365 ms
Total Talk Time (CUSTOMER): 86318 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/8da45c74-476f-4860-bb03-c56b1c110d32_20250114T17:17_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office. I'm looking on a claim status. Can you help me?
[AGENT][NEUTRAL] May I have your name again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you, [PII]. What is your callback number if we are disconnected please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I can help you with the claim status and what is that policy number, please?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 01516593ML8.
[AGENT][POSITIVE] OK, thank you so much [PII]. Let me just repeat that to you. I have that as 01516593 ML 8.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you and verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you so much for the verification process and what is the date of service and the total charge amount please?
[CUSTOMER][NEUTRAL] Yeah, the date of service for this one is [PII] for $225 even.
[AGENT][POSITIVE] OK, thank you. Again, I can help you with the claim status, but you can also check claim status by visiting our secure portal at [PII], and on that website you're able to obtain that EOB as well. Give me one moment please, [PII]. One moment. Thank you for your patience. Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and was that billed for a procedure code of 99214?
[CUSTOMER][NEUTRAL] Mm, yes.
[AGENT][NEUTRAL] OK, thank you. It shows that the claim was received and denied as office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Of visit is not covered under the patient's plan.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And may I know the patient's plan name?
[AGENT][NEUTRAL] This is a Medlink policy.
[CUSTOMER][NEUTRAL] So it's a patient responsibility.
[AGENT][NEUTRAL] APL does not determine patients responsibility.
[CUSTOMER][NEUTRAL] OK. And may I know the received and denied date?
[AGENT][NEUTRAL] Uh, certainly, of course, one moment please.
[AGENT][NEUTRAL] OK, the claim was received on [PII] and denied on, I'm sorry, processed and denied on [PII].
[CUSTOMER][NEUTRAL] And the claim number?
[AGENT][NEUTRAL] 354-499-98
[CUSTOMER][NEUTRAL] 354-499-998
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can you fax me the EOB?
[AGENT][NEUTRAL] EOB is gonna be obtained from the secure website. Um, what is that fax number, uh, faxed over to you as a courtesy.
[CUSTOMER][POSITIVE] Thank you. It's uh [PII].
[AGENT][NEUTRAL] OK, let me just confirm that that is [PII].
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Anything else I can help you with? I will get that faxed over to you.
[CUSTOMER][NEUTRAL] Uh, no. And when, when I will receive the fax?
[AGENT][NEUTRAL] You will receive the fax within the next few minutes or.
[AGENT][NEUTRAL] Within the next couple of hours, yes, you should receive that fax, but it'd be quicker if you were to log on to that website you'll be able to print it then, but again, you will get that it'll be today.
[CUSTOMER][NEUTRAL] OK. Can you spell your name for me?
[AGENT][NEUTRAL] Yes, [PII]
[CUSTOMER][NEUTRAL] Last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the call reference number?
[AGENT][NEUTRAL] We do not use the call reference numberia. You can use my name in today's date. Is there anything else I can assist you with, please?
[CUSTOMER][POSITIVE] No, that's all for today. Thank you for asking and thank you for the information you provided me on this call.
[AGENT][POSITIVE] You're welcome, [PII] and thank you so much for calling APL. You have a great day. Thank you, take care.
[CUSTOMER][POSITIVE] You too as well. Thank you. Bye. Take care.
[AGENT][NEUTRAL] Mm bye.