AccountId: 011433970860
ContactId: 9373d36a-23f8-4176-9911-f30a7dd3d499
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 365929 ms
Total Talk Time (AGENT): 146832 ms
Total Talk Time (CUSTOMER): 114157 ms
Interruptions: 2
Overall Sentiment: AGENT=2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/9373d36a-23f8-4176-9911-f30a7dd3d499_20250228T18:21_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, my name is uh [PII]. I'm calling from the provider office. May I know the claim status?
[AGENT][POSITIVE] Yes, absolutely, I'd love to help you with claim status today, June, and do you mind if I snag a quick call back number?
[CUSTOMER][NEUTRAL] Yeah. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alright perfect thank you so much and what is the policy number we wanna look at today?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] 024
[CUSTOMER][NEUTRAL] 25064.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Perfect. Would you be able to verify for me, please, your insured's first and last name and date of birth?
[CUSTOMER][NEUTRAL] All right. The patient, the first name is [PII].
[CUSTOMER][NEUTRAL] Can I spell it, the first name?
[AGENT][NEUTRAL] Hold on one second. Yeah, I think I might have the policy number wrong. I have 02475064.
[CUSTOMER][NEUTRAL] Uh, no issue. Uh, you can search about the patient name.
[CUSTOMER][NEUTRAL] Uh, the patient name is uh
[AGENT][NEUTRAL] Um, what was that policy number though?
[CUSTOMER][NEUTRAL] Just a second.
[CUSTOMER][NEUTRAL] 024
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 55064.
[AGENT][NEUTRAL] OK, I'm sorry, let me.
[AGENT][NEGATIVE] Put that in because I did type it in wrong.
[AGENT][NEUTRAL] All right, I do see [PII] here, yes, [PII] and could you verify her date of birth for me, pretty please?
[CUSTOMER][NEUTRAL] All right. [PII].
[AGENT][POSITIVE] All right, yes, thank you, thank you.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] What is the date of service on the claim we wanna look at?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] $321.
[AGENT][POSITIVE] OK, perfect. Give me just a moment please.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Like people
[AGENT][POSITIVE] Are you having a good day so far?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][POSITIVE] Are you having a good day so far?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Good glad to hear it and.
[AGENT][NEUTRAL] OK, I think I found your claim. Would you be able to verify for me?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] One second, 995, maybe that's not it.
[AGENT][POSITIVE] Perfect. Would you be able to verify for me the name of the facility on that claim?
[CUSTOMER][POSITIVE] Wow
[CUSTOMER][NEUTRAL] Yes, yes, of course. The facility name is Portland Dermatology.
[AGENT][NEUTRAL] Perfect, I do see that, and I see that we received your claim on [PII]. I show the claim number is 3499568, and that the claim was processed on [PII]. I do show that claim did deny. It does just state that office visits are not covered by the above number policy.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Was there anything else I could help you with today on this claim?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Was there anything else I could help you with today on this claim?
[CUSTOMER][NEUTRAL] Uh, the, uh, what is the, the main reason for the dinner? The office medicine not covered?
[AGENT][NEUTRAL] Oh, that's it.
[AGENT][NEUTRAL] Yeah, that's the only denial code it's just offices that they're not covered by the policy.
[CUSTOMER][NEUTRAL] All right. So, could you please one more time to, uh, again, the claim number?
[AGENT][NEUTRAL] Yes, claim number is 349-9568.
[CUSTOMER][NEUTRAL] And what is the process date?
[AGENT][NEUTRAL] It was [PII].
[CUSTOMER][NEUTRAL] [PII]. And what is the receipt date?
[AGENT][NEUTRAL] The received date was [PII].
[CUSTOMER][POSITIVE] All right. Thank you so much for that.
[CUSTOMER][NEUTRAL] Sorry, [PII].
[AGENT][NEUTRAL] [PII] to receive.
[CUSTOMER][NEUTRAL] All, all right. All right, all right.
[CUSTOMER][NEUTRAL] So, and, sorry, uh, I missed you the name. Uh, could you please spell your name?
[AGENT][NEUTRAL] Yeah, you bet you it's [PII], first initial last name, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That is your first name.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] [PII], yep.
[CUSTOMER][NEUTRAL] All right. And what is the last name?
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] All right. And what is your call reference number?
[AGENT][NEUTRAL] The reference number is my name and today's date.
[CUSTOMER][POSITIVE] All right. So thank you so much for that.
[AGENT][POSITIVE] My pleasure, [PII].
[CUSTOMER][NEUTRAL] Uh, all my doubts are clear.
[AGENT][POSITIVE] Good. I'm glad.
[CUSTOMER][POSITIVE] And I get all the information for you. Thank you so much for that. Have a good day.
[AGENT][POSITIVE] You too enjoy your Friday and have a happy weekend.
[CUSTOMER][NEUTRAL] Yeah, you too.
[AGENT][NEUTRAL] Bye-bye.