AccountId: 011433970860
ContactId: b0bfc173-50fe-44bf-b8a5-9b65984d8b44
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 734179 ms
Total Talk Time (AGENT): 149861 ms
Total Talk Time (CUSTOMER): 303602 ms
Interruptions: 13
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/26/b0bfc173-50fe-44bf-b8a5-9b65984d8b44_20250626T13:13_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. How may I help you? Hi, this is [PII] calling from provider's office to check on the claim status. Could you please spell out your name?
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status. My name is [PII] A.
[CUSTOMER][POSITIVE] OK, well, I'll be more than happy to help you with the claim status. My name is [PII] A.
[CUSTOMER][NEUTRAL] OK. Thank you, [PII]. What's, what's your last name initial?
[AGENT][POSITIVE] You're welcome and
[AGENT][NEUTRAL] [PII],
[CUSTOMER][POSITIVE] You're welcome and
[CUSTOMER][POSITIVE] [PII]. Thank you, [PII].
[AGENT][NEUTRAL] And [PII], may I have a good contact number in case?
[CUSTOMER][NEUTRAL] Yeah. I just need a general claim status. Good contact number in case.
[CUSTOMER][NEUTRAL] Yeah. Mhm.
[AGENT][NEUTRAL] May I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] Hello. Contact number in case we're disconnected and the policy number? Yeah, sure.
[CUSTOMER][NEUTRAL] Contact number is [PII].
[CUSTOMER][NEUTRAL] And the policy number is
[CUSTOMER][NEUTRAL] 02281581.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And can you verify the member's first and last name and date of birth? Yeah, sure. The member's first name is [PII] and, sorry, last name is [PII] and first name is [PII]. And the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] Thank you for that. And how many claims do you have in total today? Only one.
[AGENT][NEUTRAL] Alright, and may I have the date of service and the total bill for the claim?
[CUSTOMER][NEUTRAL] Alright, and may I have the date of service and the total bill for the plane? Yeah, sure. The date of service is uh just [PII] and the total bill amount is
[CUSTOMER][NEUTRAL] $739.
[CUSTOMER][NEUTRAL] For 1550 cents.
[AGENT][NEUTRAL] Thank you, and all the information provided is a verification of benefits, not a guarantee of payment.
[CUSTOMER][NEUTRAL] Thank you and all the information provided is a verification of benefits, not a guarantee of payment, and that was [PII]. Just a moment.
[AGENT][NEUTRAL] And that was [PII]?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yeah.
[AGENT][NEUTRAL] And the total bill was $739.50.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] And the total bill is $739.50.
[CUSTOMER][NEUTRAL] Yeah, total bill amount is $739.50. Correct?
[AGENT][NEUTRAL] All right. And do you mind if I place you on just a brief hold while I locate the claim for you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, and do you mind if I place you on just a brief hold while I locate the claim for you? Yeah.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] Thank you, hold on one moment. Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Hello, [PII]. Hi. Yeah.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So we received the claim twice. Um, did you want the original claim or the second one?
[CUSTOMER][POSITIVE] Thank you so much for holding. I apologize for that wait. So we received the claim twice. Um, did you want the original claim or the second one?
[AGENT][NEUTRAL] Or both.
[CUSTOMER][NEUTRAL] Sorry. Bye bye.
[AGENT][NEUTRAL] We received the claim twice. Would you like the claim status on the original or the second claim or both?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] We received the claim twice. Would you like the claim status on the original or the second claim, or both? Uh, uh, about the last one, the latest one.
[AGENT][NEUTRAL] So the latest one we received on [PII].
[CUSTOMER][NEUTRAL] So the um latest one we received on [PII]. Just a moment. [PII]. Yeah.
[AGENT][NEUTRAL] The claim number is 352.
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] That claim number is 352.
[AGENT][NEUTRAL] 2135.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2135. Mhm.
[AGENT][NEGATIVE] And it was denied because the policy doesn't provide anesthesia services.
[CUSTOMER][NEGATIVE] And it was denied because the policy doesn't provide anesthesia services. Just a moment.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. When it's got denied?
[AGENT][NEUTRAL] Um, hold on one second.
[CUSTOMER][NEUTRAL] Uh, hold on one second.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Just give me a moment. Uh let me check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello. Are you there?
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] Hello? Yes, I'm here. Yeah. Actually, it is not covered as per the patient's plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Hello, yeah, can we do bill to patient on this claim?
[AGENT][NEUTRAL] So there's a
[AGENT][NEGATIVE] There's a delay
[CUSTOMER][NEUTRAL] So there's a
[AGENT][NEUTRAL] Um, so we don't determine patient responsibility.
[CUSTOMER][NEGATIVE] There's a delay.
[CUSTOMER][NEUTRAL] Um, so we don't determine patient responsibilities.
[CUSTOMER][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] Could you please come again?
[AGENT][NEUTRAL] We do not determine patient responsibility.
[CUSTOMER][NEUTRAL] We do not determine patient responsibility.
[CUSTOMER][NEUTRAL] OK. So we can't build the patient, right?
[AGENT][NEUTRAL] That's up to you as the provider. We don't tell you what to do with that. We don't determine.
[CUSTOMER][NEUTRAL] That's up to you as the provider. We don't tell you what to do with that. We don't determine. OK. Just a moment. OK, just give me a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just give me a moment. Let me check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment, uh, [PII].
[AGENT][NEUTRAL] OK, that's fine.
[CUSTOMER][NEUTRAL] Just give me a
[CUSTOMER][NEUTRAL] So, can we uh made an appeal on this claim?
[AGENT][NEUTRAL] I mean, you always have a right to an appeal, but yes, you'll have to, you'll have to give me a minute in between responses because there's a delay.
[CUSTOMER][NEUTRAL] Hello [PII], are you there? I mean, you always have a right to an appeal, but Yes, you'll have to, you'll have to give me a minute in between responses because there's a delay. OK, OK. Sorry for that. Could you please help me out with the appeal filing limit? It's OK, so there.
[AGENT][NEUTRAL] It's OK. So there.
[AGENT][NEUTRAL] OK, hold on. Let me answer your question. So you can file an appeal, but the policy doesn't cover anesthesia. So if you appeal it and the policy still doesn't cover it.
[CUSTOMER][NEUTRAL] OK, hold on, let me answer your question.
[CUSTOMER][NEUTRAL] No, but the policy doesn't cover anesthesia. So if you appeal it and the policy still doesn't cover it, it would still be denied, but you can send in an appeal if you like. OK.
[AGENT][NEUTRAL] It would still be denied, but you can send in an appeal if you like.
[CUSTOMER][NEUTRAL] OK. OK, then I, it's OK, fine. Please help me with the filing.
[AGENT][NEUTRAL] The appeal is 180 days from the denial date.
[CUSTOMER][NEUTRAL] The appeal is 180 days from the denial date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for that.
[CUSTOMER][NEUTRAL] Uh, yeah.
[CUSTOMER][NEUTRAL] Could you please help me with the call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial and my last name is [PII]. OK. Thank you, [PII]. Thank you, [PII]. Uh, yeah. Could you please help me with the fax number?
[AGENT][NEUTRAL] So, um, our fax number is [PII].
[CUSTOMER][NEUTRAL] So, um, our fax number is [PII].
[CUSTOMER][NEUTRAL] Uh, it's [PII], right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hello. [PII]. Mhm. [PII]. OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII]. OK. Thank you for that.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Thank you for providing this information. Have a nice day and bye for now.
[AGENT][NEUTRAL] You also, was there anything else I can help you with today, [PII]?
[CUSTOMER][POSITIVE] You also, was there anything else I can help you with today, [PII]? No, nothing else. Thank you.
[AGENT][POSITIVE] All right, thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Alright, thanks for calling APL bye bye.