AccountId: 011433970860
ContactId: ace97b59-51c1-4a76-9062-f6e2fcb6b614
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 228539 ms
Total Talk Time (AGENT): 99195 ms
Total Talk Time (CUSTOMER): 56061 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/ace97b59-51c1-4a76-9062-f6e2fcb6b614_20250224T17:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] with the Center for Women's Health. I need to check the status of a medical claim.
[AGENT][POSITIVE] OK, [PII], happy to check on claim for you today. Do we have a policy number?
[CUSTOMER][NEUTRAL] Um, it's gonna be 02320079.
[AGENT][POSITIVE] Alright, thank you so much let me pull this up here.
[AGENT][NEUTRAL] And if I could get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII] and her date of birth is [PII].
[AGENT][POSITIVE] Alright thank you so much and then what's the date of service?
[CUSTOMER][NEUTRAL] I actually have two, but the first date is gonna be [PII] for $312.
[AGENT][NEUTRAL] OK, let me take a look for that one.
[AGENT][NEUTRAL] $312.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do we by chance have an amount um due after the primary?
[CUSTOMER][NEUTRAL] I do. It's um $100.18.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so it looks like we did receive a claim for the state of service. It was received on [PII]. We did send a benefit payment in the amount of $100.18 in a single check it looks like.
[CUSTOMER][NEUTRAL] Can you tell me what address that was mailed to?
[AGENT][POSITIVE] Yeah, absolutely, let me pull that up here.
[AGENT][NEUTRAL] Uh, payment was made to uh [PII], and it was sent to [PII].
[CUSTOMER][NEUTRAL] Yeah, OK, um, I have one more data service for that same patient.
[AGENT][NEUTRAL] OK, not a problem. What's the other day?
[CUSTOMER][NEUTRAL] It's 113 of 2025. The total bill is 312, but the balance after the primary is 14397.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Ok we got.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so for this claim, it looks like we did receive it. It was denied, denial reason states policy provides no benefits for treatment of conditions other than sickness or injury.
[CUSTOMER][NEUTRAL] OK, so the patient can be billed for that?
[AGENT][NEUTRAL] Yeah, that would be up to the provider facility to build them that, yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, alright, is there a call reference um number for today?
[AGENT][NEUTRAL] Absolutely. Call reference is my name with my last initial and then today's date. My name again is [PII], which is [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, thank you sir have a great day.
[AGENT][NEUTRAL] You too bye bye.
[CUSTOMER][NEUTRAL] OK, bye bye.