AccountId: 011433970860
ContactId: bba3f792-adb8-4c2b-9150-43474f9e84d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 306950 ms
Total Talk Time (AGENT): 92731 ms
Total Talk Time (CUSTOMER): 79749 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/bba3f792-adb8-4c2b-9150-43474f9e84d3_20250324T14:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi. Um, my name is [PII] and I'm calling from provider's office to check on the claim status. How are you doing today?
[AGENT][POSITIVE] I'm good, [PII]. Thanks for asking. I'm happy to help with the claim status. What is the patient policy number?
[CUSTOMER][NEUTRAL] Uh, just one second.
[CUSTOMER][NEUTRAL] Yeah, the policy number of the member is 02536444.
[AGENT][NEUTRAL] All right, thank you, [PII]. And do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh the first name, it is uh [PII], and the last name, [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] Uh, it is [PII].
[AGENT][POSITIVE] Thank you. Data service.
[CUSTOMER][NEUTRAL] Uh, it is uh [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][NEUTRAL] So [PII]?
[CUSTOMER][POSITIVE] Yes, ma'am, exactly.
[AGENT][NEUTRAL] OK, what's the bill amount?
[CUSTOMER][NEUTRAL] Uh, it's $250 even.
[AGENT][NEUTRAL] $206 even.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, so it looks like we did receive a claim for this state of service. Claim is received on [PII].
[AGENT][NEUTRAL] The claim was denied. It looks like outpatient treatment is only covered in an emergency room, urgent care or physician's office. So where the patient had treatment was not covered.
[CUSTOMER][NEUTRAL] Uh, it is not covered as per patient's plan or, or as per provider's plan, ma'am.
[AGENT][NEUTRAL] Uh, per the patient plan.
[CUSTOMER][NEUTRAL] OK. Uh, can I have the claim number?
[AGENT][NEUTRAL] Claim number is 357.
[AGENT][NEUTRAL] 1697.
[CUSTOMER][NEUTRAL] OK. Uh, can you please spell your name?
[AGENT][NEUTRAL] My name is spelled [PII].
[CUSTOMER][NEUTRAL] OK. Can I have the call reference number?
[AGENT][NEUTRAL] Call references my name with my last initial than today's date. My name again is [PII], last initial is [PII].
[AGENT][NEUTRAL] Is there anything else I can help with today?
[CUSTOMER][NEUTRAL] Uh, you said the, the call reference number is your name, uh, [PII], and this, uh, date?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK. Can you please uh tell me when was the claim denied?
[AGENT][NEUTRAL] Claim was denied on [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much for this information. Hope you're having a great day.
[AGENT][NEUTRAL] You too. Bye bye.