AccountId: 011433970860
ContactId: b18cf33a-bef3-42aa-9b46-ee66c7ea6cf7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 419359 ms
Total Talk Time (AGENT): 91639 ms
Total Talk Time (CUSTOMER): 85300 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/b18cf33a-bef3-42aa-9b46-ee66c7ea6cf7_20250409T17:53_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, uh, this is [PII] calling for provider to check on additional information about a claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes.
[AGENT][NEUTRAL] OK [PII], I can help you with your claim status sir. Can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yes, the callback number is [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you sir and then what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Name of the facility is Palm Beach Orthopedic Institute.
[AGENT][NEUTRAL] OK, and then may I get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yes, it is uh [PII]. Date of birth is [PII]. And the policy number is 1423698.
[AGENT][NEUTRAL] OK, let me pull up that policy real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you, sir. I appreciate you holding for me.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's gonna be just a second, it's trying to pull it in now.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and um you said that the claim was has already been originally denied can you please give me the claim number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh no, let me get the claim number for you.
[AGENT][NEUTRAL] Yes sir, your time [PII].
[CUSTOMER][NEUTRAL] My number is.
[CUSTOMER][NEUTRAL] Policy number, check date. OK. Claim number is 357-888-85.
[AGENT][NEUTRAL] OK. I'm what was that policy number 368885?
[CUSTOMER][NEUTRAL] No, no, that's the claim number. 357-888-85.
[AGENT][NEUTRAL] 357-888-85. OK, I'm gonna put you on a brief hold while I look up this claim and I will be right back, [PII].
[CUSTOMER][NEUTRAL] OK. And your name, please?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, OK. You can take your time. Thank you.
[AGENT][POSITIVE] Thank you, sir. Bye-bye.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], this is [PII]. Um, first of all, let me give you the correct policy number.
[CUSTOMER][NEUTRAL] Yup.
[AGENT][NEUTRAL] The correct policy number is 1,950,960.
[CUSTOMER][NEUTRAL] Oh yeah, yeah.
[AGENT][NEUTRAL] And the claim was denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK, office visits are not covered.
[CUSTOMER][NEUTRAL] So the patient, and may I know the patient plant type?
[AGENT][NEUTRAL] Medlik
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] A patient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] meddling.
[CUSTOMER][NEUTRAL] OK. And the claim processed it or the denied it?
[AGENT][NEUTRAL] OK, let me, let me look that up real quick.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Yes, sir. That's correct.
[CUSTOMER][POSITIVE] OK. Thank you so much so much.
[CUSTOMER][NEUTRAL] OK. And the call reference for this?
[AGENT][NEUTRAL] You can use my name which is [PII] and today's date.
[CUSTOMER][POSITIVE] OK, [PII]. Thank you so much and have a wonderful day. Take care, bye.
[AGENT][POSITIVE] You have a wonderful day too, [PII]. There's nothing else I can help you with before we go?
[CUSTOMER][POSITIVE] No, that's it. Uh. Thank you.
[AGENT][POSITIVE] OK. You take care and thanks for calling APL. Bye-bye, sir.
[CUSTOMER][NEUTRAL] Yup.
[CUSTOMER][NEUTRAL] Bye.