AccountId: 011433970860
ContactId: 99a1051e-8e53-4a98-ab2e-e0b75f0ccb05
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 207699 ms
Total Talk Time (AGENT): 73317 ms
Total Talk Time (CUSTOMER): 85331 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/99a1051e-8e53-4a98-ab2e-e0b75f0ccb05_20250421T13:38_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello, this is [PII]. Thanks for calling APL. How can I assist you?
[CUSTOMER][NEUTRAL] Hello, [PII]. This is [PII] calling on behalf of provider's office. I'm here for a clarification over a claim. So can you please help me out with that?
[AGENT][NEUTRAL] Oh sure, of course I can. You said your name was [PII]?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Ma'am, thank you. I think I spoke with you earlier. Can I have a callback number for you and that policy number that you're checking the status of a claim for?
[CUSTOMER][NEUTRAL] Yeah, yeah, sure. The callback number is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And the policy number?
[CUSTOMER][NEUTRAL] Yeah, it's 02588453.
[AGENT][NEUTRAL] Thank you, [PII], and what is the member's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] And what is the date of service that you're calling to check the status of a claim for?
[CUSTOMER][NEUTRAL] Yeah, yeah, sure. The date of service is uh [PII]. Total charge amount is $388 even.
[AGENT][NEUTRAL] And what is your procedure called Sam?
[CUSTOMER][NEUTRAL] Uh, procedure code is 76536.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] So looks like this claim was received [PII] and it was processed [PII]. However, it was submitted by the insured. I can't give you any information on it, unfortunately.
[CUSTOMER][NEUTRAL] Uh, why, why is that so?
[AGENT][NEUTRAL] Because the the insured, the insured submitted the claim and not the facility itself, you will have to submit the claim on your own behalf.
[CUSTOMER][NEUTRAL] OK, so we have to submit the claim on, OK.
[AGENT][NEUTRAL] Yes, you have to submit the claim. You guys didn't submit a claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So who had submitted the claim now then?
[AGENT][NEUTRAL] The insured, the patient.
[CUSTOMER][NEUTRAL] Remember?
[CUSTOMER][NEUTRAL] OK. So we have to submit the claim. No worries. So, can you just, uh, when was, uh, can you, do you have the claim number?
[AGENT][NEGATIVE] No, I can't give you that.
[CUSTOMER][NEUTRAL] OK, we have to submit the claim. In short, there is no claim on file. We have to submit as a uh uh provider, we have to submit the claim.
[AGENT][NEUTRAL] Yes, because you didn't, you haven't submitted a claim for the data service.
[CUSTOMER][NEUTRAL] So, uh, as a provider, we have to, you mean to say as a provider, we have to submit the claim from our, from our end, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Uh, can you just spell your name, ma'am?
[AGENT][NEUTRAL] [PII], and today's date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Uh, the call reference number will be, yeah, the call reference number will be your name and today's date.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK. No worries.
[AGENT][POSITIVE] Thanks for calling APL and have a great day, [PII].
[CUSTOMER][NEUTRAL] Yeah, you too.
[AGENT][NEUTRAL] Bye.