AccountId: 011433970860
ContactId: cdf4553a-66a7-47f9-b61b-ddd0da542d5c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 328679 ms
Total Talk Time (AGENT): 110019 ms
Total Talk Time (CUSTOMER): 101889 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/cdf4553a-66a7-47f9-b61b-ddd0da542d5c_20250312T17:42_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from provider office.
[CUSTOMER][NEUTRAL] For the
[CUSTOMER][NEUTRAL] Oh hello?
[AGENT][NEUTRAL] OK, that's better. And what's your name?
[CUSTOMER][NEUTRAL] Are you
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] How can I help you, [PII]?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I'm looking for the claim status.
[AGENT][NEUTRAL] OK, we can help you and what's the policy number?
[CUSTOMER][NEUTRAL] Uh, policy number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Wait for a second, sir. This is D as in Delta 45401062.
[AGENT][NEUTRAL] Spell the patient's first and last name.
[CUSTOMER][NEUTRAL] The patient's first name is [PII] and last name is [PII].
[AGENT][NEUTRAL] Spell the first and last name for me please.
[CUSTOMER][NEUTRAL] Uh [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And last name is [PII]
[AGENT][NEUTRAL] OK, and what's the uh the the good call back number in case we're disconnected?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the patient's date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you for verifying that information for me [PII] and you said that you're checking a claim status we can assist with that information. What's the date of service in charge?
[CUSTOMER][NEUTRAL] And date of service is [PII].
[CUSTOMER][NEUTRAL] And the total bill amount is
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It's $335 even.
[AGENT][NEUTRAL] 3:35.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] What's the procedure code on the claim?
[AGENT][NEUTRAL] Or is it, is it the office visit and then?
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, I see it.
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Also, could you please spell your name? I'm sorry.
[AGENT][NEUTRAL] Mhm. [PII], first initial last name is [PII], and you'll use my name and today's date as reference for today's call.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I do show that this claim was received.
[AGENT][NEUTRAL] On
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Processed on [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Not showing a payment.
[CUSTOMER][NEUTRAL] And what's the status?
[AGENT][NEUTRAL] Yeah, I'm not showing a payment made on the claim, uh, the remark code says that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The outpatient rider only allows payment for outpatient surgery in an outpatient hospital or a physician's office.
[AGENT][NEUTRAL] That's gonna be for the.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Office visit code.
[AGENT][NEUTRAL] And then for
[CUSTOMER][NEUTRAL] Uh, so this was not.
[AGENT][NEGATIVE] Yeah, the, the, the, the services are not covered. They're not covered under the patient's policy.
[CUSTOMER][NEGATIVE] This claim was denied.
[CUSTOMER][NEUTRAL] OK. Wait for a second, please.
[CUSTOMER][NEUTRAL] Not covered under patient responsibility. Patient, yes.
[AGENT][NEUTRAL] I said it's not the services are not covered under the patient's policy. We do not determine patient's responsibility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have any other questions I can assist with today, uh, Mr. [PII]?
[CUSTOMER][NEUTRAL] Mm Yes, wait for a second, please.
[CUSTOMER][NEUTRAL] OK. So what's the claim number?
[AGENT][NEUTRAL] That claim number is 3436453.
[AGENT][NEUTRAL] I think I've spoken with you before, [PII], but just as a reminder you can also check status online at [PII] and anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh the reference number is your name and to today's date.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And what's your uh name spelling? Can you please spell it, uh, once again?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] First initial
[CUSTOMER][POSITIVE] OK, sir, thank you.
[CUSTOMER][NEUTRAL] OK, OK. [PII], yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, la. So, thank you for this information. Have a nice day.
[AGENT][POSITIVE] You're welcome thanks for calling APL have a good day as well.