AccountId: 011433970860
ContactId: 9cc55f97-cccc-4a65-9af0-f325512cbbad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 714049 ms
Total Talk Time (AGENT): 177846 ms
Total Talk Time (CUSTOMER): 173716 ms
Interruptions: 3
Overall Sentiment: AGENT=1.2, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/9cc55f97-cccc-4a65-9af0-f325512cbbad_20250423T20:08_UTC.wav
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[AGENT][POSITIVE] Thank and APS this is [PII]. How may I help?
[AGENT][NEUTRAL] Hello this is [PII] with APL. How may I help you?
[CUSTOMER][NEUTRAL] Can you hear me now?
[AGENT][NEUTRAL] Hello? Yes, I can hear you now. There you are.
[CUSTOMER][NEUTRAL] Can you hear?
[AGENT][NEUTRAL] I can hear you.
[CUSTOMER][POSITIVE] Yeah, I'm sorry for that.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And um what is your name?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, Miss [PII], what is your callback number just in case the call gets dropped.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] I'm sorry to inform that your voice is in and out. Could you please check your connection?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, I will do that for you. Hold on real quick.
[AGENT][NEUTRAL] OK, Ms. [PII], how can I help you today?
[CUSTOMER][NEUTRAL] I'm checking on a denial claim.
[AGENT][NEUTRAL] OK, I can help you with that. Can you please give me the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number, which is gonna be 04012021. 1st and last name of the patient is [PII]. Date of birth for [PII]. Before moving on, could you please spell your name?
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. And what is the patient's data service of the claim?
[CUSTOMER][NEUTRAL] Date of service for [PII] for the total charge of $294 even.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you. Let me look up that policy real quick.
[AGENT][NEUTRAL] OK, so looking under policy 04012021, I do not find a member under that policy number.
[CUSTOMER][NEUTRAL] under.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] Do you see another number?
[CUSTOMER][NEUTRAL] Let me check that here.
[CUSTOMER][POSITIVE] Oh, I'm so sorry for that.
[AGENT][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] 1 2nd.
[AGENT][NEUTRAL] Or if you have the social I can pull it in with the social also.
[CUSTOMER][NEUTRAL] OK, let me just check that here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, check with this policy ID which is 023-236772.
[AGENT][POSITIVE] That sounds like a good number. Let me check that one.
[CUSTOMER][POSITIVE] That sounds like a good
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. OK, I have her pulled up. And what is the charge amount after the primary paid their part?
[CUSTOMER][NEUTRAL] Ok, I have it pulled up and what are the charge amount after.
[CUSTOMER][NEUTRAL] OK. After the primary paid.
[CUSTOMER][NEUTRAL] The total bill amount is $294 even.
[AGENT][NEUTRAL] OK and then can you please give me the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] I'm calling from Associates and Dermatology PLLC.
[AGENT][NEUTRAL] OK, Ms. [PII], I'm gonna put you on a quick hold while I look this claim up and I'll be right back with you.
[CUSTOMER][NEUTRAL] M. [PII], I'm gonna put you on a quick hold while I look this claim and I'll be right back.
[CUSTOMER][POSITIVE] Yeah, sure, take your time.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] And thank you for holding for me, Ms. [PII].
[AGENT][NEUTRAL] So I have the claim pulled up. The claim number is 356-452-7.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the claim has been denied because office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] 1
[CUSTOMER][NEUTRAL] Uh, could you please repeat again the claim number, please? I'm sorry.
[AGENT][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] The claim number is 356-452-7.
[CUSTOMER][NEUTRAL] OK. Actually, I do have a claim number here which is 3587273. And this has been denied as a duplicate. So, the one which you are providing me is the original claim status?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, that's, that's gonna be the original claim.
[CUSTOMER][NEUTRAL] OK. When did you receive this original claim, ma'am?
[AGENT][NEUTRAL] Yes, we received it on.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We received the
[AGENT][NEUTRAL] I'm on [PII] and processed it on [PII].
[CUSTOMER][NEUTRAL] OK. As office visit is not covered in the patient's plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So, what will be the next step for this claim?
[AGENT][NEUTRAL] Uh, the claim has been processed and denied.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] So that would be up to the provider to decide what to do next.
[CUSTOMER][NEUTRAL] OK, one second please.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Just give me a minute. Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes ma'am, take your time.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] So, uh, thank you so much for being on hold. I really appreciate your patience.
[AGENT][POSITIVE] Not a problem at all.
[CUSTOMER][NEUTRAL] Uh, can you please confirm the specific plan details that exclude the office visit?
[AGENT][NEUTRAL] It's just non-covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK, just the under nonco under the main policy, OK.
[AGENT][NEGATIVE] Right, there are no benefits under this policy for office visits.
[AGENT][NEUTRAL] Per the policy contract.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] Is there any alternate codes that might be built under the, uh, I mean, that might be covered under the patient's plan?
[AGENT][NEGATIVE] I can't assist with that. That would be falsifying records.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for that information. Can I get the call reference for this call, please?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes ma'am, you can use my name and today's date.
[CUSTOMER][POSITIVE] So thank you so much for that information, [PII]. You have a great day and safe best bye for now.
[AGENT][POSITIVE] You too, Ms. [PII], thank you so much for calling APL. Is that everything I can help you with?
[CUSTOMER][NEUTRAL] Yes
[AGENT][POSITIVE] OK, bye bye and you have a wonderful night.
[CUSTOMER][POSITIVE] Thank you bye bye.