AccountId: 011433970860
ContactId: 95732c44-5f4a-4a0f-9357-6f456d217370
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 493970 ms
Total Talk Time (AGENT): 116534 ms
Total Talk Time (CUSTOMER): 110933 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/95732c44-5f4a-4a0f-9357-6f456d217370_20250513T14:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, [PII], my name is [PII], and I'm calling from provider office and I'm looking for a claim status of the patient.
[AGENT][NEUTRAL] Sure, [PII], I can help you with claim status. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, my callback number is [PII].
[AGENT][NEUTRAL] Can I get the policy number?
[CUSTOMER][NEUTRAL] The uh the uh sure. Policy number of this claim is 02279731 M as in Mary, L as in Lima.
[CUSTOMER][NEUTRAL] Number 8.
[AGENT][NEUTRAL] All right, one moment while I pull that up.
[CUSTOMER][POSITIVE] Sure. Take your time.
[AGENT][POSITIVE] Are you having a good day?
[CUSTOMER][NEUTRAL] So, the date of service?
[AGENT][NEUTRAL] Oh, I was asking if you had a good day.
[CUSTOMER][POSITIVE] Yeah, yeah, yeah. Good. And you?
[AGENT][POSITIVE] It's good.
[CUSTOMER][NEUTRAL] N
[AGENT][NEUTRAL] Sorry, my computer is running a little slow today.
[AGENT][NEUTRAL] Can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's first name is [PII] and the last name is [PII] And the date of birth of the patient is [PII].
[AGENT][POSITIVE] Alright. Thank you so much. Give me one moment.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][NEUTRAL] And what was the date of service?
[CUSTOMER][NEUTRAL] The days of service of this patient is [PII]. The bill amount is $779 even.
[AGENT][NEUTRAL] $779 even. One moment.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And would you like that claim number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, the claim number is 35.
[AGENT][NEUTRAL] 85729
[AGENT][NEUTRAL] And I do show a charge of $779 even.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEGATIVE] It looks like that claim was denied.
[AGENT][NEUTRAL] Uh, please provide copies of the explanation of benefits from the primary insurance carrier.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This is a Medlink policy, which is a gap policy, so major medical will need to pay first.
[CUSTOMER][NEUTRAL] Please provide.
[AGENT][NEUTRAL] And then we'll need the explanation of benefits from that before we can process this.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And what is the primary insurance as for you, uh, you?
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] Give me just one moment, OK?
[CUSTOMER][POSITIVE] Sure, take your time. I'm on the call.
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] It looks like the primary insurance is Aetna.
[CUSTOMER][NEUTRAL] Uh, they look like to do.
[AGENT][NEUTRAL] Or Gravi, G R A V I E.
[CUSTOMER][NEUTRAL] Primary
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Aetna.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And if you have uh any member, uh member ID of that, no?
[AGENT][NEUTRAL] I do not. You will have to call the patient to get that from them.
[CUSTOMER][NEUTRAL] Uh, I did the call of the patient. OK, just to let me.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Just a moment, let.
[CUSTOMER][NEUTRAL] OK I does mm.
[CUSTOMER][NEUTRAL] Sure, it's Aetna, Aetna. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh what is the received date of this claim?
[AGENT][NEUTRAL] It looks like we received this claim on the [PII].
[CUSTOMER][NEUTRAL] And what is the process date?
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][POSITIVE] And uh thank you so much for your giving information. What's the call reference number of this one?
[AGENT][NEUTRAL] We don't have a call reference number that you can use my name and my last initial, it's [PII] as in hospital, and today's date.
[CUSTOMER][NEUTRAL] And what?
[CUSTOMER][NEUTRAL] And what
[CUSTOMER][NEUTRAL] What is the spell of your name?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] and then last name [PII] in today's date.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Today's date.
[CUSTOMER][POSITIVE] Thank you so much, [PII], for your giving information and it's nice talking to you. Have a nice day.
[AGENT][POSITIVE] Thank you so much for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Bye.