AccountId: 011433970860
ContactId: b1a91188-b42a-4f69-8af2-ee6dd066c348
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 565440 ms
Total Talk Time (AGENT): 150672 ms
Total Talk Time (CUSTOMER): 164939 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/b1a91188-b42a-4f69-8af2-ee6dd066c348_20250618T14:11_UTC.wav
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[AGENT][POSITIVE] This is easy. How can I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hi, I'm [PII] calling from provider office to check on our claim status. Could you please spell your name for me?
[AGENT][NEUTRAL] Um, it's [PII] It's spelled [PII] and my last initial is [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Sure, [PII], I can assist you with claim status. Could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] 8
[CUSTOMER][NEUTRAL] The callback number is [PII].
[AGENT][NEUTRAL] Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] It's 022 03915.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] The patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. Now, I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] The date of service is [PII].
[CUSTOMER][NEUTRAL] With the charge amount of $5,584 even.
[AGENT][NEUTRAL] OK. Yes, sir. We received that claim on.
[AGENT][NEUTRAL] We received the claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[AGENT][NEUTRAL] The claim number is 355.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 0113.
[AGENT][NEUTRAL] And this claim denied because under this policy for outpatient services, we cover up to 6000 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that amount was met. Yeah, that amount was met, um, let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can I have the amount once again, it's $66,000 per year, am I right?
[AGENT][NEUTRAL] Yes, 6000 per calendar year.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And that amount was met on
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It was met on uh [PII].
[CUSTOMER][NEUTRAL] OK. Uh, please give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, can authorization over at this denied?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] No, I cannot.
[CUSTOMER][NEUTRAL] Yes sir uh authorization is possible.
[AGENT][NEUTRAL] No authorization possible because the benefit max was reached. We only cover up to 6000 per calendar year and that maximum was reached on a previous claim.
[CUSTOMER][NEUTRAL] OK. Uh, can I have the call reference number? I do have one another one more thing.
[AGENT][NEUTRAL] Yes, the call reference number is my name and today's date. My name is [PII]. Um it's spelled [PII] Last initial is [PII], and today's date.
[CUSTOMER][NEUTRAL] OK. Uh, can I, uh, I do have one more claim. Could you please?
[AGENT][POSITIVE] OK. Yes, I'm ready for the policy number.
[CUSTOMER][NEUTRAL] Help me with that?
[CUSTOMER][NEUTRAL] Um, just a second.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 922
[CUSTOMER][NEUTRAL] OK, can I go ahead with that policy number?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] It's.
[CUSTOMER][NEUTRAL] 02185075 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK. And what's the date of service and bill charges on the claim?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] With the charge amount of $2790 even.
[AGENT][NEUTRAL] OK, please repeat those bill charges.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The charge amount is $2790 even. It's 2790.
[AGENT][NEUTRAL] OK, yes, sir. We received that claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It.
[AGENT][NEUTRAL] The claim number is 3562628.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And this claim is denied because services provided in office are not covered under the policy.
[CUSTOMER][NEUTRAL] OK. Uh, just, uh, please give me a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Uh, it's not covered under the patient's plan or the provider's plan?
[AGENT][NEUTRAL] The patient's plan.
[CUSTOMER][NEUTRAL] OK. Can I have the plan name and the plan type?
[AGENT][NEUTRAL] Medlink, M [PII]
[AGENT][NEUTRAL] And it's Gap Insurance, GAP Insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And the type of, what's the type?
[AGENT][NEUTRAL] Gap GAP.
[CUSTOMER][NEUTRAL] OK. The plan is middling and the insurance type is GA Insurance. Am I right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can you bill the patient for this?
[AGENT][NEUTRAL] Please repeat the question.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, uh, we can build the patient.
[AGENT][POSITIVE] Yes, sir, you can build the patient.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Mhm. Please give me a moment. Let me check if I need anything.
[CUSTOMER][NEUTRAL] Is there any equipment on this claim?
[AGENT][NEUTRAL] Please repeat the question.
[CUSTOMER][NEUTRAL] Is there any equipment on this claim?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, that's it. Can I have the call reference number for this?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date.
[CUSTOMER][NEUTRAL] OK. Uh.
[CUSTOMER][POSITIVE] Yeah, thank you. Thanks for assisting me. Have a great day. Bye-bye.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling IPL. bye.
[CUSTOMER][NEUTRAL] OK