AccountId: 011433970860
ContactId: b7a00fc1-3c36-441b-a313-52b5e83cdfe6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 743570 ms
Total Talk Time (AGENT): 163631 ms
Total Talk Time (CUSTOMER): 166513 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/b7a00fc1-3c36-441b-a313-52b5e83cdfe6_20250402T19:59_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling in regard points of use. Are you just need information about a claim?
[AGENT][NEUTRAL] OK, [PII], I can help you with the claim. Can you please give me your callback number?
[CUSTOMER][NEUTRAL] Yes, of course. It's going to be [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Ponsa cures.
[AGENT][NEUTRAL] OK, and can I please get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Of course. The name is going to be [PII].
[CUSTOMER][NEUTRAL] Uh, date of birth is going to be [PII] and the policy number it's going to be 02331423.
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then can you please give me the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Yes, of course. It's going to be [PII].
[CUSTOMER][NEUTRAL] And the amount bill is going to be 162.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Their part.
[CUSTOMER][NEUTRAL] Sorry, I think the call breaks for a moment. Can you please repeat that?
[AGENT][NEUTRAL] Yes, what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Uh, let me just to confirm, it's just missing $25 a about a copay.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you and I'm gonna put you on a brief hold while I look up this claim and I'll be right back.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Oh my goodness.
[AGENT][NEUTRAL] How many times you gonna send a claim in?
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK [PII], thank you very much for holding for me. I do have the claim for you. The claim number is 346-4106, and the claim was denied because the outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh, I see. Well, in this case, we can build the patient, right? In your experience?
[AGENT][NEUTRAL] Uh, we don't give patient responsibility. We let the provider determine that.
[CUSTOMER][POSITIVE] OK, I understand. Wonderful. Now, by any chance can you look up another claim for me? I, I just have two more.
[AGENT][NEUTRAL] OK, yes, I can, um, what is the next member's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK, the next member is going to be [PII]. Date of birth [PII].
[CUSTOMER][NEUTRAL] And the policy number, it's going to be, give me just one second, it's going to be 02270585.
[AGENT][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[CUSTOMER][NEUTRAL] See I don't think that way and that yeah that's not.
[AGENT][NEUTRAL] OK, and then what is the date of service and the charge amount for this one, please?
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so the date of service is going to be [PII].
[CUSTOMER][NEUTRAL] And the amount charged is going to be 188, and after the primary pay it's 25, another copay.
[AGENT][NEUTRAL] OK, OK, I'm gonna put you on a brief hold while I pull this one up for us and I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], thank you very much for holding for me. So I have this claim for you. Uh, the claim number is 3546586.
[AGENT][NEUTRAL] This claim was also denied because the maximum outpatient office visits for the year were met.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, wonderful. Now, can we go with the 3rd claim?
[AGENT][NEUTRAL] OK, and what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK, give me just one moment, but my system is a little bit slow so just give me one second, OK?
[AGENT][POSITIVE] Yes, please take your time. I completely understand.
[CUSTOMER][NEUTRAL] OK, so the next one is going to be for [PII]. Date of birth [PII].
[CUSTOMER][NEUTRAL] And the policy number is going to be the next one. Just a second.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] It's going to be 022003895.
[AGENT][NEUTRAL] OK, so that's 02203895.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, alright, let me look up that one.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Fatal.
[CUSTOMER][NEUTRAL] Yeah, that's me.
[AGENT][NEUTRAL] What is the person in charge of [PII].
[CUSTOMER][NEUTRAL] Oh yes, the charge amount it's going to be.
[CUSTOMER][NEGATIVE] $528 and after the primary one paid it's $30 of another copay.
[AGENT][NEUTRAL] OK, so the charge is $528 and then after is $30 correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and then what is the date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] OK, brief hold again. I'm gonna look this one up and I'll be right back.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Wonderful.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you so much [PII] for holding for me so I have the claim pulled up for you. Uh, this claim number is 342-9609 and this claim was denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Oh, I see. OK, wonderful. Thank you very much for all the, for this information. Now, the only thing I just need is what is the reference nu[PII] for the call?
[AGENT][NEUTRAL] You can use my name [PII] in today's date.
[CUSTOMER][POSITIVE] OK, well, thank you very much for all this information. Hope you have a wonderful day. Goodbye.
[AGENT][POSITIVE] Thank you too, [PII]. Thank you for calling APL. You have a great day also. Bye-bye.