AccountId: 011433970860
ContactId: 9931f4a1-d5ba-4a29-80f5-43f2d07703cc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 922390 ms
Total Talk Time (AGENT): 219969 ms
Total Talk Time (CUSTOMER): 227816 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/9931f4a1-d5ba-4a29-80f5-43f2d07703cc_20250416T15:41_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi. Uh, good morning. My name is [PII] and last name is [PII]. I'm calling from provider's office regarding the claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status, sir. May I please get your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Sure. [PII]. It is a direct line.
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The patient name is [PII] and the date of birth is [PII].
[CUSTOMER][NEUTRAL] And the member ID [PII] [PII].
[AGENT][NEUTRAL] OK, let me look up that policy real quick. I do see uh her policy. May I please get, I'm sorry, his policy. May I please get the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The date of service is [PII] and the total charge $348 even.
[AGENT][NEUTRAL] And that's 348.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and then what is the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] OK. Just give me a moment. It's loading.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's loading still.
[AGENT][POSITIVE] Yes, sir. Go ahead and take your time.
[CUSTOMER][NEUTRAL] So, how is going today?
[AGENT][POSITIVE] I'm going good today how are you?
[CUSTOMER][POSITIVE] Yeah, good. Thank you for asking.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] So 2 days more for the weekend, right? So what's your weekend plan?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, it's [PII] weekend, so we're gonna have [PII] with our family.
[AGENT][NEUTRAL] And go to church.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, you are going to church?
[AGENT][NEUTRAL] Yes, and we're gonna eat.
[AGENT][NEUTRAL] Eat food.
[CUSTOMER][NEUTRAL] Hm
[AGENT][POSITIVE] Have a family gathering.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] So I think I expected that the food is also very tasty, so that's why your family are going to eat the whole ri.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK. Yeah. Thank you for the waiting. Um,
[CUSTOMER][NEUTRAL] OK. The primary paid one second.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] Uh, sorry for the inconvenience. Actually, the claim is already
[CUSTOMER][NEUTRAL] Posted in my system.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Wait one second.
[CUSTOMER][NEUTRAL] Let's move, uh, the, uh, sorry for the inconvenience. Let's move to the another patient.
[AGENT][NEUTRAL] OK. The next patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] OK, it's loading.
[CUSTOMER][NEUTRAL] Yeah, um, the patient name is [PII], and the date of birth is [PII].
[CUSTOMER][NEUTRAL] And the member ID [PII] [PII].
[AGENT][NEUTRAL] OK, let me pull up her policy real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and then what's on this uh data service and charge amount?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the total charge $9 even.
[AGENT][NEUTRAL] OK, and the charges after the primary?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The primary pay is $0 and the copy is up $1.80 so the remaining balance is $1.80.
[AGENT][NEUTRAL] OK, thank you. And then what is the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] Gastro Health LLC.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold, [PII], while I look up this claim and I'll be right back, sir.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, [PII], thank you so much for holding for me. I have the claim ready for you.
[CUSTOMER][POSITIVE] Yeah, I'm ready.
[AGENT][NEUTRAL] The claim number is 3574803.
[AGENT][NEUTRAL] The claim was denied because the services were rendered after the termination date of the policy and the policy terminated on [PII], and there's no active policies for this member.
[CUSTOMER][NEUTRAL] OK, and when they affected date?
[AGENT][NEUTRAL] The effective date was [PII].
[CUSTOMER][NEUTRAL] OK, ma'am, you have any other insurances?
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] OK. Can you please provide the receipt it and process it?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] We received the claim on [PII] and processed it on [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much. Um, just give me a moment. I'm downloading the Yi through portal.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, it's boarding.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you please send any yogi through fax? Uh, I'm trying to download the Yogi through portal, but it is showing on your phone.
[AGENT][POSITIVE] Yes, I can.
[AGENT][NEUTRAL] Yes, what's your fax number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, let me put you on a quick hold so I can get that fax ready for you and I'll be right back, [PII].
[CUSTOMER][NEUTRAL] Yeah, sure. And also, can you please put attention my name, [PII], OK?
[AGENT][NEUTRAL] OK, I will do that.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I have that fax on its way to you now.
[CUSTOMER][POSITIVE] Yeah, sure. Thank you and last the last claim.
[AGENT][NEUTRAL] OK, and what is the member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK. Like previously, we discussed the first claim, right? So I choose the wrong claim ID so that's why I'm saying it's incorrect. OK. The member ID is 02569537 [PII] for [PII].
[CUSTOMER][NEUTRAL] And the patient name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK and then what is the date of service and the charge amount for this one?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and the total charge is $348 even.
[AGENT][NEUTRAL] OK, and then the charges after the primary?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, the primary's boarding.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, the primary pay $2 and the co-pay $80 so the balance amount is $80 even.
[AGENT][NEUTRAL] $80. OK, and then is this one also for Gastrohealth?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, alright, quick hold again I'm gonna look this claim up for us and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you [PII] for holding for me. I have the claim ready for you and the claim number is 3551956.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the claim was denied because office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the received date and the date?
[AGENT][NEUTRAL] Yes sir, let me look that up.
[AGENT][NEUTRAL] We received the claim on [PII] and processed it on [PII].
[CUSTOMER][POSITIVE] OK. Thank you and thank you for giving this information. Can you please spell your name?
[AGENT][NEUTRAL] Yes, sir. It's [PII]
[CUSTOMER][POSITIVE] Yeah. Thank you, [PII]. Thank you for giving this information and have a nice day and once happy weekend.
[AGENT][NEUTRAL] You're
[AGENT][POSITIVE] Thank you. You too, [PII]. You have a wonderful weekend too. Is that all I can help you with today?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, well you have a wonderful weekend and thank you for calling APL.
[CUSTOMER][POSITIVE] Yeah, same to you. Bye-bye. And enjoy your food.
[AGENT][NEUTRAL] Bye-bye, sir.
[AGENT][POSITIVE] Thank you. I will. I appreciate that. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah. Bye bye.