AccountId: 011433970860
ContactId: b6b95926-a3b4-48ab-9553-d2d7e2af7cfd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 378670 ms
Total Talk Time (AGENT): 111903 ms
Total Talk Time (CUSTOMER): 83763 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/b6b95926-a3b4-48ab-9553-d2d7e2af7cfd_20250306T18:26_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. I'm calling from provider office. Yeah about checking claim status.
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status, Mr. [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, and you're calling from which facility from my location?
[CUSTOMER][NEUTRAL] Mm, yeah.
[AGENT][NEUTRAL] What's the name?
[CUSTOMER][NEUTRAL] Yeah, policy.
[CUSTOMER][NEUTRAL] So the facility name.
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] Mm, yeah, integral rheumatology and Immunology.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, 0140581 M as in Mike, L as in Lima, number 8.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Um, can you repeat that number one more time? I don't think I have all the numbers.
[CUSTOMER][NEUTRAL] 0140581 ML 8.
[AGENT][NEUTRAL] Yes, missing adja, do you have the copy of the card?
[CUSTOMER][NEUTRAL] Just wait, I check the information mm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah please find the patient name.
[CUSTOMER][NEUTRAL] And then date of birth?
[AGENT][NEUTRAL] And what's the spelling of the last name?
[CUSTOMER][NEUTRAL] Mm, yeah. Right, [PII].
[AGENT][NEUTRAL] OK, what's the spelling of the first name?
[CUSTOMER][NEUTRAL] Mm, yeah, [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] May I have the date of birth?
[CUSTOMER][NEUTRAL] Mm, uh, [PII].
[AGENT][NEUTRAL] OK. OK I found her. And you say you need claim status. What is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] [PII]. How much is the total charge?
[CUSTOMER][NEUTRAL] Yeah, $398.68.
[CUSTOMER][NEUTRAL] Well, see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, we received the claim on [PII] and we processed on [PII] and the claim was denied. The reason for this denial is that the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEGATIVE] Services are not covered.
[CUSTOMER][NEUTRAL] But why?
[AGENT][NEUTRAL] When performed.
[AGENT][NEUTRAL] In a doctor's office or clinic.
[CUSTOMER][NEUTRAL] This plan is not covered for this amount, right?
[AGENT][NEUTRAL] The service is not covered when performed in a doctor's office or clinic, meaning that we do not cover service rendered in office or clinic.
[CUSTOMER][NEUTRAL] OK. Uh, this amount is a patient responsibility.
[AGENT][NEUTRAL] It's up to the provider's discretion. We don't have any contractual involvement with this. This is the secondary policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you need the claim number or any other information, Mr. [PII]?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah, please provide the claim number.
[AGENT][NEUTRAL] That is 356-5001.
[CUSTOMER][NEUTRAL] Please spell your name.
[AGENT][NEUTRAL] That's [PII], that's initial [PII].
[CUSTOMER][NEUTRAL] OK, please provide the callback reference number.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][POSITIVE] OK, yeah, thank you also.
[AGENT][POSITIVE] OK, thank you for calling APO. Have a good afternoon, Mr. [PII].