AccountId: 011433970860
ContactId: ca71776e-4556-49f0-8e12-bcdac77cb215
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 284989 ms
Total Talk Time (AGENT): 83130 ms
Total Talk Time (CUSTOMER): 81718 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=2.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/ca71776e-4556-49f0-8e12-bcdac77cb215_20250523T14:24_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII] calling from Pediatrics Medical Group of Florida to check on claims denial.
[AGENT][NEUTRAL] OK, I can verify claim status for you and you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes, that's right. Uh, by the way, would you mind, could, uh, could you spell your name for me?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, it's [PII], last initial [PII]
[AGENT][NEUTRAL] And Ms. [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah, sure. My callback number is [PII]. Uh, it is a direct line that was my extension.
[AGENT][NEUTRAL] OK, and do you have the policy number, please?
[CUSTOMER][NEUTRAL] Sure. The policy number is 02455481 M as in Mike L as in Lima 8.
[AGENT][POSITIVE] Thank you so much. Give me one moment please.
[AGENT][NEUTRAL] OK. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So the patient's name is [PII] and the date of birth is on [PII].
[AGENT][NEUTRAL] Thank you and you say you're calling for claim status correct?
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] Uh, what was that data service and amount of the charge?
[CUSTOMER][NEUTRAL] Sure, the date of services on [PII] and the total charge amount is $3,204 even 3204.
[AGENT][NEUTRAL] OK, and do you have the balance after primary insurance has processed the claim?
[CUSTOMER][NEUTRAL] Yeah. Uh, the balance, uh, is $140.
[AGENT][POSITIVE] OK, thank you, give me one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and you're calling from?
[CUSTOMER][NEUTRAL] I'm calling from Pediatrics Medical Group of Florida INC.
[AGENT][POSITIVE] OK, thank you. Give me one moment.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] One moment, Miss [PII].
[CUSTOMER][POSITIVE] Take your time.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK OK OK.
[CUSTOMER][POSITIVE] Sure take your time.
[AGENT][NEUTRAL] I show on this claim, it looks like we pay $70 and that was for code 76825. The other code processes office visits are not covered per the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure. So, since it is not covered for the policy, uh, can you bill the patient for the services?
[AGENT][NEUTRAL] Uh, we can't give patient responsibility. We can only verify how the claim was processed.
[CUSTOMER][NEUTRAL] Sure, so you cannot verify if we can't bill the patient. Am I right?
[AGENT][NEUTRAL] Correct, we cannot say it would be patient responsibility we can only verify how the claim was processed.
[CUSTOMER][POSITIVE] Sure, thank you, thank you for assisting me. May I have your reference number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, if you like, you may use my name at today's date. And is there anything else, Miss [PII], I can assist you with today?
[CUSTOMER][POSITIVE] No, thank you. Thank you for assisting me. Have a great day.
[AGENT][POSITIVE] Alright, you too. Thank you for calling APL.
[CUSTOMER][POSITIVE] Yeah, take care, bye bye.
[AGENT][NEUTRAL] Bye.