AccountId: 011433970860
ContactId: c3e10e88-587e-44f6-ae2e-0cca42be71a8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1178420 ms
Total Talk Time (AGENT): 204363 ms
Total Talk Time (CUSTOMER): 201456 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=-1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/c3e10e88-587e-44f6-ae2e-0cca42be71a8_20250122T17:59_UTC.wav
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[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 from provider's office and to check for the claim status.
[AGENT][NEUTRAL] OK [PII], I can help you with claim status. Can you please give me your callback number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name?
[CUSTOMER][NEUTRAL] The patient's name is uh [PII].
[AGENT][NEUTRAL] OK, and the patient's date of birth?
[CUSTOMER][NEUTRAL] The patient's date of birth, [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's policy number?
[CUSTOMER][NEUTRAL] It's 025361997.
[AGENT][NEUTRAL] OK, let me look that up.
[AGENT][NEUTRAL] OK, thank you and then what is the date of service?
[CUSTOMER][NEUTRAL] Rate of service is 108-2024.
[AGENT][NEUTRAL] And the charge
[CUSTOMER][NEUTRAL] Um, I have two charge amounts for the same date.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One is for $265.
[CUSTOMER][NEUTRAL] And another one is for $24.
[AGENT][NEUTRAL] OK, and what is the name of the facility you're calling for?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Radilogy Imaging Associates.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I look up this claim for you, [PII], and I'll be right back.
[CUSTOMER][NEUTRAL] Uh um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. So looking at the policy for Evan Friday, um, data service 108 of 2024, I'm not finding any claims on file for this insured.
[CUSTOMER][NEUTRAL] Uh, for 108 2024, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, I have the claim number.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] OK, I'm listening, sir.
[CUSTOMER][NEUTRAL] Hi. Yes, I have the claim number. It's 3.
[AGENT][NEUTRAL] What is the number?
[CUSTOMER][NEUTRAL] 352.
[CUSTOMER][NEUTRAL] 1416
[AGENT][NEUTRAL] OK, I'm gonna put you on hold and look that claim up. I'll be right back.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK [PII], um, I see what the where the problem was the policy number you gave me 253-6197.
[CUSTOMER][NEUTRAL] 53
[AGENT][NEUTRAL] Is not the policy number the claim was filed under the claim was filed the policy number 253-6267.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, uh, so you got the claim, right?
[AGENT][NEUTRAL] Yes, I got the claim. The claim was denied. The medical test for this data service is not a covered diagnostic test. Therefore, no for this claim. Covered tests include MRI, CAT scan, thyroid uptake test, CT scans.
[CUSTOMER][NEUTRAL] was.
[CUSTOMER][NEUTRAL] They
[AGENT][NEUTRAL] PET scans and grams barium enema lower GI series. So this is not a covered diagnostic test under this dental policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. And uh uh actually, uh, we have previously called and uh we got the status and also uh we have requested the EOB through fax. So, but we didn't receive the EOB. So, uh, could you please uh send me the EOB through fax because we have requested multiple times for UOB. That means explanation of benefit.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] But we, but we didn't receive the EOBT lounge, so could you please send me the AOB?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, what is your number?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Uh, the fax number is
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 5100.
[AGENT][NEUTRAL] OK, and that's [PII]?
[CUSTOMER][NEUTRAL] No, no. That's [PII].
[AGENT][NEUTRAL] OK, let me repeat [PII].
[CUSTOMER][NEUTRAL] 5100.
[AGENT][NEUTRAL] Yes, OK, OK you on hold while I get that fax. I'm gonna send it to you while we're on the phone together since you had an issue getting it, so it's gonna be just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Come on.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, [PII]. I have that fax on its way to you now.
[CUSTOMER][NEUTRAL] OK. And I do have uh um one more time.
[AGENT][NEUTRAL] OK, I can help you with one more claim. Can you please give me the insured the uh patient's name?
[CUSTOMER][NEUTRAL] Uh, yeah, the same patient.
[AGENT][NEUTRAL] OK, what is the claim number?
[AGENT][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] What is the date of service?
[CUSTOMER][NEUTRAL] No, I will give you the claim number because uh I have the claim number.
[AGENT][POSITIVE] Oh good.
[AGENT][POSITIVE] Yes, that would be perfect. Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's 352.
[CUSTOMER][NEUTRAL] 1416.
[AGENT][NEUTRAL] OK, and is it for the same policy number, the 253-626-7?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, I'm gonna put you on hold while I pull that in. I'll be right back sir.
[CUSTOMER][NEUTRAL] Uh, OK. And uh you can use my name. My name is not [PII]. For attention, you can use my name.
[AGENT][NEUTRAL] Oh, it's [PII]. I'm sorry, I thought it was [PII]. I apologize, thank you for correcting me on that. It's gonna be just a moment.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 5362
[AGENT][NEUTRAL] OK, [PII]. Thank you for holding for me. I do see the claim and the claim was denied for the same reason. It's not a covered diagnostic test.
[CUSTOMER][NEUTRAL] I do see the claim and the.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] Yeah. Could you please uh send me the UOB through fax?
[AGENT][NEUTRAL] Yes, I'm gonna put you on hold. I'm gonna take care of that. I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], I have that EOB on its way to you now.
[CUSTOMER][POSITIVE] OK. Um, thank you so much for your assistance and uh could you please spell your name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] OK, may I know the call reference number?
[AGENT][NEUTRAL] Yes, sir. You can use my name and today's date.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh, your name and today's date, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Thank you. Uh thank you so much for your assistance and have a wonderful day. Take care. Bye-bye.
[AGENT][POSITIVE] You too thank you thanks for calling APL you have a good week.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mm bye-bye, [PII].