AccountId: 011433970860
ContactId: c28f0094-e19b-4b3c-b5dd-883c37af92e1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 796559 ms
Total Talk Time (AGENT): 185665 ms
Total Talk Time (CUSTOMER): 142188 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/c28f0094-e19b-4b3c-b5dd-883c37af92e1_20250131T18:24_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, good afternoon. My name is [PII], and last time initial [PII]. I'm calling from provider's office regarding claim status.
[AGENT][NEUTRAL] OK [PII], I can help you with claim status. Can you please give me your callback number?
[CUSTOMER][NEUTRAL] Yeah, sure. [PII]. It is a direct line.
[AGENT][NEUTRAL] Thank you sir and then what is the name of the insured of the patient?
[CUSTOMER][NEUTRAL] Like you're asking the insurance name?
[AGENT][NEUTRAL] The name of the patient?
[CUSTOMER][NEUTRAL] OK, uh, just give me a moment, it's loading.
[CUSTOMER][NEUTRAL] Yeah. The patient name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth, [PII]?
[AGENT][NEUTRAL] OK, and what's the patient's date of birth? I'm sorry, policy number?
[CUSTOMER][NEUTRAL] 1758964
[AGENT][POSITIVE] Thank you. Let me pull in that policy real quick.
[AGENT][NEUTRAL] OK, and what is the data service?
[CUSTOMER][NEUTRAL] Yeah, the date of service is [PII] and the total charge $4050 even 4050.
[AGENT][NEUTRAL] OK, and what was that date again? [PII] what day?
[CUSTOMER][NEUTRAL] The [PII] sorry, [PII]. [PII].
[AGENT][NEUTRAL] OK and then um what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] OK, just a moment.
[CUSTOMER][NEUTRAL] $45 is that?
[AGENT][NEUTRAL] OK, and what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] I'm calling from Gastro Health LLC.
[AGENT][NEUTRAL] OK, and that um just to be clear that data service was 8223.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, alright, [PII], I'm gonna put you on a brief hold while I look up the claim for you and I'll be right back.
[CUSTOMER][POSITIVE] Yes, sure. Take your time.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh my. It's been a day. It's been a day.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Hi [PII] thank you so much for holding for me I do have the claim for you.
[AGENT][NEUTRAL] The claim number is 335-0510.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim was denied because outpatient services are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK. Out of, uh, outpatient services are not called on the patient policy?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Have
[CUSTOMER][NEUTRAL] My God.
[CUSTOMER][NEUTRAL] One second on the patient policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] May I know the claim date and that date?
[AGENT][POSITIVE] Yes sir, let me look that up for you real quick.
[AGENT][NEUTRAL] We received the claim on [PII] and processed the claim on [PII], we received the claim on [PII] and process the claim on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][POSITIVE] OK, thank you. Let's move to the end.
[AGENT][NEUTRAL] OK, what's the next member's name?
[CUSTOMER][NEUTRAL] Yeah. The next member name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth [PII].
[AGENT][NEUTRAL] OK, and what's [PII]'s policy number?
[CUSTOMER][NEUTRAL] 23061.
[AGENT][NEUTRAL] Mm, that's not a policy number.
[CUSTOMER][NEUTRAL] Is there any chance, can you please check with patient name and date of birth?
[AGENT][NEUTRAL] Yes, can you spell the first name for me?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, let me see if I can find them.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And what kind of claim is this going to be? Medical, dental, hospital?
[AGENT][NEUTRAL] Accident, what kind is it gonna be?
[AGENT][NEUTRAL] Are you there?
[CUSTOMER][NEUTRAL] Yes, sir, sir. It's medical.
[AGENT][POSITIVE] Medical. OK. That helps me. Thank you, sir.
[AGENT][NEUTRAL] OK, and then what is the date of service? I'm sorry, first let me ask you.
[AGENT][NEUTRAL] Let's see, make sure her birthday is correct.
[AGENT][NEUTRAL] Yes, we got the same birthday. OK, what is the date of service?
[CUSTOMER][NEUTRAL] It's [PII] and total charge $542 even.
[AGENT][NEUTRAL] OK, and what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] OK, 1 2nd.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $60 even.
[AGENT][NEUTRAL] And the name of the facility is still the same?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'm gonna put you on hold again. I'm gonna look her up. I'll be right back.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding, [PII]. I'm back with you again. So I do have this claim. The claim number is 3410239.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim was denied because office visits are not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The policy number is 1978563.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim was received on [PII] and it was processed on [PII].
[CUSTOMER][NEUTRAL] OK. Thank you. And that's it. Can you please provide the
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Call reference number?
[AGENT][NEUTRAL] Yes, you can use my name, [PII], and today's date.
[CUSTOMER][POSITIVE] Yeah. Thank you, [PII]. Thank you for giving this information. Have a nice day and happy weekend.
[AGENT][POSITIVE] Happy weekend to you too, [PII]. You take care. Thanks for calling APO bye bye.
[CUSTOMER][NEUTRAL] Yeah, bye bye.