AccountId: 011433970860
ContactId: 8eaa88cc-bc8e-4d54-a2f7-9ddb94f93fab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 578969 ms
Total Talk Time (AGENT): 117664 ms
Total Talk Time (CUSTOMER): 193404 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/8eaa88cc-bc8e-4d54-a2f7-9ddb94f93fab_20250522T13:22_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Good morning, sir. My name is [PII] and I have a friend.
[AGENT][NEUTRAL] I cannot hear you. Um, there's a lot of muffle in the back.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Can you get a little bit closer to the phone.
[CUSTOMER][NEUTRAL] Not that
[CUSTOMER][POSITIVE] I like that.
[CUSTOMER][NEUTRAL] It's probably.
[AGENT][NEUTRAL] I can still not hear you well. Can I get your name?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello? Can you hear me now?
[AGENT][NEUTRAL] Hello, yeah, I can, yes, I can hear you now. Um, may I have your name?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure, I'm [PII]
[AGENT][POSITIVE] Thank you. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] OK. And what is the reason of your call, Mrs. [PII]?
[CUSTOMER][NEUTRAL] Um, this is, uh, regarding for a claim.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] And may I have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] It's the curators of the University of Missouri.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure, um.
[CUSTOMER][NEUTRAL] It's 02300419.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] OK. Patient's name is um [PII]. Date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you and may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Sure, native service is.
[CUSTOMER][NEUTRAL] [PII] total charge amount is 476.75.
[AGENT][NEUTRAL] Date of service you said is um [PII]?
[CUSTOMER][NEUTRAL] Yes, this year.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, let me see if I can find this claim. For future, you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] OK, [PII]
[AGENT][NEUTRAL] And let's see.
[CUSTOMER][NEUTRAL] I'm sorry, [PII], right?
[AGENT][NEUTRAL] So
[AGENT][POSITIVE] [PII]. Yes, that is correct. Mhm.
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] And bear with. OK, you're welcome. One moment, I'm waiting on the AOB to pull up, OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, so it looks like we processed the claim on [PII].
[AGENT][NEUTRAL] And the claim was denied. The reason for this denial is that let's see.
[AGENT][NEUTRAL] Outpatient facilities is not covered under this policy.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] So regarding for this one since you mentioned that this is not covered for outpatient facility um this is um we can bill this one to the patient, right?
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] It's up to the provider's discretion. We don't have any contractual involvement on the remaining.
[CUSTOMER][NEUTRAL] 00 yeah.
[AGENT][NEUTRAL] So the, the provider will take the decision. Mhm.
[CUSTOMER][NEUTRAL] So you, OK, give me a second, let me just um put that here in my note. One moment.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. Sure.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] One moment, so
[AGENT][POSITIVE] Sure, yes, take your time.
[CUSTOMER][NEUTRAL] OK, so, uh, just want to confirm, so, uh, thanks for waiting. So this one, which is was processed on [PII] of this year and it was denied because, um, our patient has still been covered for this one, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] And also that this is um uh this not regards to uh we cannot mail this one to the patient this is regards to uh provider's discretion correct.
[CUSTOMER][NEUTRAL] Just like
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, one second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] One moment, so.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um, so, so, um, thanks for patiently waiting. Um, can I ask for your last name initial?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] And [PII] thank you um.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Can I have also the caller reference number?
[AGENT][NEUTRAL] We don't have reference numbers, so can you use my name in today's date.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Oh, so and they say.
[CUSTOMER][NEUTRAL] So I just wanted to make sure that this one is not covered uh not covered under the outpatient, the sales fee and the um insurance and the provider which is has not a contract if this is a patient responsibility.
[CUSTOMER][NEUTRAL] Or we can build this one to the patient. It depends on the provider's discretion, correct?
[AGENT][NEUTRAL] OK OK.
[CUSTOMER][POSITIVE] OK, thank you so much so for assisting me and have a great day, OK? Enjoy your day.
[AGENT][POSITIVE] You as well, you're as well. Thank you for calling APL. Bye-bye. You're welcome.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] Thank you so much sir.
[AGENT][POSITIVE] You're welcome.