AccountId: 011433970860
ContactId: 9862ee86-3cf3-4c00-87e2-c719e1229bb1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 183309 ms
Total Talk Time (AGENT): 85086 ms
Total Talk Time (CUSTOMER): 56453 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/9862ee86-3cf3-4c00-87e2-c719e1229bb1_20250519T13:51_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. My name is [PII]. I am calling from the provider's office in regards to a claim.
[AGENT][NEUTRAL] OK, and excuse me, [PII], what is your callback number? I'm so sorry.
[CUSTOMER][NEUTRAL] That's OK [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you so much, and may I have the policy number please?
[CUSTOMER][NEUTRAL] That is.
[CUSTOMER][NEUTRAL] 223.
[CUSTOMER][NEUTRAL] 0106.
[AGENT][POSITIVE] OK, I have that as 2230106. Thank you.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], excuse me, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you very much. One moment please.
[AGENT][NEUTRAL] And you're calling for claim status. I can certainly help you with that. Um, what is that date of service and the total charge amount please, [PII]?
[CUSTOMER][NEUTRAL] 1211 24.
[CUSTOMER][NEUTRAL] Uh, $600.06.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, and just to confirm that was [PII] for $600.06. OK, thank you. It shows us a facility charge. We received the claim and it denied as benefits are not covered if it's not due to a sickness or an injury.
[CUSTOMER][NEUTRAL] OK, not due to a sickness or injury.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I have that claim number for you.
[CUSTOMER][NEUTRAL] Hold on a second I'll make a note here if I can spell.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I'm sorry, not covered.
[AGENT][NEUTRAL] Um, due to a sickness or an injury. So if it wasn't a visit, um, due to a sickness or injury, it looks like this was maybe a wellness or preventative visit.
[AGENT][NEGATIVE] And it's not covered.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, fabulous um yes go ahead with that claim number if you will please.
[AGENT][NEUTRAL] Of course. It is 359-6413.
[CUSTOMER][POSITIVE] OK fabulous thank you um and is there a reference number for our call then?
[AGENT][NEUTRAL] Uh, no, but you can use my name in today's state and also you're able to obtain an EOB, a copy of the EOB on our website at [PII]. You can also check claim status that way, but if you like, I can fax it over to you, um, the ELB if you need that.
[CUSTOMER][NEUTRAL] Um, no, that's OK, thank you though. Uh, can I get initial to your last name real quick?
[AGENT][POSITIVE] OK, you're welcome.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK fabulous thank you very much for your help I appreciate it.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a great day, bye.
[CUSTOMER][NEUTRAL] You too bye.