AccountId: 011433970860
ContactId: bf75a1d1-2d61-4c5f-82e8-86bb8b93e149
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 408980 ms
Total Talk Time (AGENT): 131875 ms
Total Talk Time (CUSTOMER): 118293 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/bf75a1d1-2d61-4c5f-82e8-86bb8b93e149_20250320T16:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Desert Shores Pediatrics. How are you?
[AGENT][POSITIVE] I'm good, [PII]. How are you today?
[CUSTOMER][NEUTRAL] I'm good thank you I'm just calling to follow up on a couple of claims.
[AGENT][POSITIVE] OK, I'm happy to check on claims for you today. Do we have that patient's policy number?
[CUSTOMER][NEUTRAL] Uh, yes, one moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Patient's policy number is 021-53310.
[AGENT][NEUTRAL] All right, thank you. Let me just pull that up here.
[AGENT][NEUTRAL] And [PII], do you have a good call back number just in case if we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that. And then what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII], uh, date of birth is [PII].
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] All right, thank you so much. And then what is the date of service?
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] And the build amount?
[CUSTOMER][NEUTRAL] $303.
[CUSTOMER][NEUTRAL] Looks like claim was submitted to you guys on [PII]. We haven't gotten a response just yet.
[AGENT][NEUTRAL] OK, let's see. All right.
[AGENT][NEUTRAL] 3
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like we did get a claim from you guys. It looks like the claim was denied. It looks like benefits not payable for other condition other than sickness or injury.
[CUSTOMER][NEUTRAL] Unless you said can you repeat the denial?
[AGENT][NEUTRAL] Yes, ma'am, uh, policy only provides benefit for a condition, sickness or injury, so no benefits were payable because.
[CUSTOMER][NEUTRAL] OK, let me take a look and see what was done.
[CUSTOMER][NEUTRAL] Oh so it's for a while.
[AGENT][NEUTRAL] And if you need I can also send you a copy of the COB.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Yes, that would be wonderful. Can you, are you able to email or fax it?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, we can fax it if that works for you, [PII].
[CUSTOMER][NEUTRAL] OK, yeah, give me one second to give you that.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] OK, our fax number is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 5858 and if you could make it attention to Amber.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][POSITIVE] That'd be perfect and then I have another, um, I'm sorry I have another patient.
[AGENT][POSITIVE] Yeah, no, not a problem. We can double check that one too, um.
[CUSTOMER][NEUTRAL] Let me just make a note here.
[AGENT][NEUTRAL] Yeah, no problem. I'm just getting this EOB sent over here, so.
[CUSTOMER][NEUTRAL] And then can I have a call reference number for today before I forget.
[AGENT][NEUTRAL] Mhm. Yeah, so call reference is gonna be my name and then my last initial with today's date. My first name again is [PII], which is [PII] and my last initial is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And then [PII] you can give me that next policy number whenever you're ready.
[CUSTOMER][POSITIVE] OK, one second, I'm so sorry.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Even, even
[CUSTOMER][NEUTRAL] OK, the next policy number is gonna be 018.
[CUSTOMER][NEUTRAL] 17289
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], that's [PII], uh date of birth is uh [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then data service.
[CUSTOMER][NEUTRAL] Uh [PII] of this year.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so I'm not showing any claims on file for that date of service for [PII].
[CUSTOMER][NEUTRAL] Oh let me see.
[CUSTOMER][NEUTRAL] OK, it looks like we just actually sent over a paper claim to you guys, so I, I just need to allow more time for that one.
[AGENT][NEUTRAL] Yeah, probably because I don't see oh I do you know what? I see one that's pending but there's no claim number assigned or anything yet, so we did receive it, it's just in process.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Name is [PII].
[CUSTOMER][NEUTRAL] And so
[CUSTOMER][POSITIVE] Perfect thank you so much.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And that was all I needed today.
[AGENT][POSITIVE] OK, sounds good [PII]. Well, thanks for calling APL. I hope you have a good rest of your day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye bye