AccountId: 011433970860
ContactId: 9b89364e-08c1-46e6-b526-558befef3039
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 518340 ms
Total Talk Time (AGENT): 142647 ms
Total Talk Time (CUSTOMER): 134023 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/28/9b89364e-08c1-46e6-b526-558befef3039_20250228T16:19_UTC.wav
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[AGENT][POSITIVE] Thank you for
[AGENT][NEUTRAL] Calling APL this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII] calling from provider office. I want to know current status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Can I please get your callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Yeah, callback number is [PII].
[AGENT][NEUTRAL] Thank you. And what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Patient name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII]. Member ID is 01640962.
[AGENT][NEUTRAL] OK, let me pull up that policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, can you spell the um patient's first name for me, please?
[CUSTOMER][NEUTRAL] Yeah. [PII].
[CUSTOMER][NEUTRAL] And same Gunther, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much. Let's see.
[AGENT][NEUTRAL] OK, I am.
[AGENT][NEUTRAL] Showing that we have um patient center with the policy number 1601640962.
[CUSTOMER][NEUTRAL] Sorry, sorry, your voice is breaking. Could you repeat again?
[AGENT][NEUTRAL] 0
[CUSTOMER][NEUTRAL] I'm I audible?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, 01640962.
[AGENT][NEUTRAL] The policy number you gave me?
[CUSTOMER][NEUTRAL] No. 01640969.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Let me look that up real quick.
[AGENT][NEUTRAL] Alright, and then what is the date of service?
[CUSTOMER][NEUTRAL] Um date of service is [PII].
[CUSTOMER][NEUTRAL] And charge amount is $2,679.
[AGENT][NEUTRAL] And the charge
[CUSTOMER][NEUTRAL] $2,679.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Primary, uh, do you need primary charge amount?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello, I'm sorry, can you repeat that?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEGATIVE] Actually, your voice is not clear. It's breaking.
[AGENT][NEUTRAL] Can you repeat the amount, the balance left over after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] $2,679.
[CUSTOMER][NEUTRAL] Is a charge amount?
[AGENT][NEUTRAL] OK, and then what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Piedmont and Thames Regional Medical Center.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold, [PII] while I look up this claim for us and I'll be right back.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I have the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3553668.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim has two remarks um for denial. Please provide a diagnosis code for this date of service.
[AGENT][NEUTRAL] And then the second one is we need the explanation of benefits from the primary insurance carrier.
[AGENT][NEUTRAL] Which has the diagnosis for treatment.
[CUSTOMER][NEUTRAL] Uh sorry, uh, claim denied for three reasons, right?
[AGENT][NEUTRAL] 2.
[CUSTOMER][NEUTRAL] The reason for dinner, OK?
[CUSTOMER][NEUTRAL] Uh, I'm audible?
[AGENT][NEUTRAL] Yes, again, um, we need the diagnosis code and we need the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] OK. Uh you need extension of benefits for primary information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And, and the diagnosis code.
[CUSTOMER][NEUTRAL] OK, thank you. Just allow me a moment.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, claim is denied for explanation of benefits, so you need uh UV right? primary UOB.
[AGENT][NEUTRAL] Yes, we need the primary EOB and the diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um, kindly provide me fax number for Sandy OB.
[AGENT][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, thank you. Attention to.
[AGENT][NEUTRAL] Uh, claims
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And could you also provide me?
[CUSTOMER][NEUTRAL] Uh, uh, um, could you spell your name, please?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] OK, thank you. And can you provide me call reference number.
[AGENT][NEUTRAL] You can use my name and today's date.
[CUSTOMER][POSITIVE] Thank you, thank you for having.
[AGENT][POSITIVE] You're very welcome, [PII]. You have a good weekend and thank you for calling APL.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Right.