AccountId: 011433970860
ContactId: c0ef839e-9497-4d3d-aa21-603749ea72d8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 198820 ms
Total Talk Time (AGENT): 65309 ms
Total Talk Time (CUSTOMER): 87457 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/c0ef839e-9497-4d3d-aa21-603749ea72d8_20250206T16:12_UTC.wav
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[AGENT][NEUTRAL] For calling APL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Uh, hi, this is [PII] and I'm calling from provider's office. Uh, I just called, uh, to get one information. May I get a fax number to send a bill uh for uh medical provider, medical services?
[AGENT][NEUTRAL] OK, um, the fax number is [PII].
[CUSTOMER][NEUTRAL] Hm?
[CUSTOMER][NEUTRAL] [PII]. Could you please repeat one more time?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Hm?
[CUSTOMER][POSITIVE] Yeah, thank you so much. And uh uh so we, we can able to send the bill for uh medical services also, right? For, to this uh fax number?
[AGENT][NEUTRAL] Do you have a claim number?
[CUSTOMER][NEUTRAL] Yeah, yes, I do have a claim number.
[AGENT][NEUTRAL] OK, um, and if I can get a good callback number for you?
[CUSTOMER][NEUTRAL] 312
[CUSTOMER][NEUTRAL] 248
[CUSTOMER][NEUTRAL] 7900.
[AGENT][NEUTRAL] OK, and what is that claim number?
[CUSTOMER][NEUTRAL] 35.
[CUSTOMER][NEUTRAL] 26
[CUSTOMER][NEUTRAL] 341.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, patient name is uh [PII].
[CUSTOMER][NEUTRAL] Uh, date of birth, uh, [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment.
[AGENT][NEUTRAL] Um, so this, um, claim was denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you would like to file an appeal.
[CUSTOMER][NEUTRAL] Yeah, actually, we received the correspondence letter stating that uh the claim denied as non-covered service under the, under this policy.
[AGENT][POSITIVE] That's correct, um.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] I'm showing that durable medical, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Uh, and the, in the
[CUSTOMER][NEUTRAL] Yeah, you you are saying something you can continue please.
[AGENT][NEGATIVE] I'm showing that durable medical equipment is not a covered benefit under the policy. That's why it was denied.
[CUSTOMER][NEUTRAL] OK. And is it a patient responsibility as per your records?
[AGENT][NEUTRAL] Uh, we don't determine patient responsibility, but if that's, if you want to build them, then you can, but we don't determine patient responsibility.
[CUSTOMER][NEUTRAL] Because in the
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, OK. Then uh we'll submit an appeal uh to the fax number which you gave me, uh, and, uh.
[CUSTOMER][NEUTRAL] May I, may I get your name?
[AGENT][NEUTRAL] My name's [PII]. Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] Uh, no, thank you so much and may I get the call reference number?
[AGENT][NEUTRAL] Reference is just my name [PII], and the date and time of the call.
[CUSTOMER][POSITIVE] Thank you so much, [PII], for the information that you have provided and have a nice day.
[AGENT][POSITIVE] Thank you for calling APL have a good day.
[CUSTOMER][NEUTRAL] Yeah, bye bye.
[AGENT][NEUTRAL] Bye bye.