AccountId: 011433970860
ContactId: d1083a60-1fcf-4e93-abbc-870aa832b010
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 606599 ms
Total Talk Time (AGENT): 116491 ms
Total Talk Time (CUSTOMER): 212288 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/d1083a60-1fcf-4e93-abbc-870aa832b010_20250612T16:37_UTC.wav
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[AGENT][NEUTRAL] APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from provider's office to check on the claim status.
[AGENT][POSITIVE] I'd be happy to assist with claim status today, [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Callback number is [PII]. It's a direct line.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] The policy number is 02292666.
[AGENT][NEUTRAL] I'm sorry, repeat that for me.
[CUSTOMER][NEUTRAL] Sure. It's 02.
[CUSTOMER][NEUTRAL] 292666
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] The patient's first name was [PII]. The last name was [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] And the
[AGENT][NEUTRAL] And what's the date of service for the claim?
[CUSTOMER][NEUTRAL] I'm looking for the data services of [PII]. The total charge amount is $416 even.
[AGENT][NEUTRAL] And what is the tax ID?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The tax ID is [PII].
[AGENT][NEUTRAL] I'm sorry, what was the, the amount of the charges?
[CUSTOMER][NEUTRAL] It's uh $416 even. It's a 416.
[AGENT][NEUTRAL] OK, I'm showing the claim denied because we need the EOB from the primary insurance.
[CUSTOMER][NEUTRAL] Can I get the claim the date and the process date?
[AGENT][NEUTRAL] Yes, claim was received on.
[AGENT][NEUTRAL] [PII], claim denied on [PII].
[CUSTOMER][NEUTRAL] Can I get the claim number?
[AGENT][NEUTRAL] Claim number is 358-054-7.
[CUSTOMER][NEUTRAL] OK. Could you please send the
[CUSTOMER][NEUTRAL] You go to the fax?
[AGENT][NEUTRAL] What's the fax number?
[CUSTOMER][NEUTRAL] Fax number is [PII]. Attention to my name, [PII] S.
[CUSTOMER][NEUTRAL] Uh, I don't have one more question before sending to the fax.
[CUSTOMER][NEUTRAL] Is it possible to send to the email?
[AGENT][NEUTRAL] No, we, we, we have to fax it.
[AGENT][NEUTRAL] Or you can log into the um provider.
[CUSTOMER][POSITIVE] OK, sure. Thank you
[AGENT][NEUTRAL] To the online service center for provider and you can download the ELB from there.
[CUSTOMER][NEUTRAL] Can I get the photo link, the address?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK I'm sure I'll check with that and
[CUSTOMER][NEUTRAL] Can I get the numbers effective on termination date?
[AGENT][NEUTRAL] Effective [PII] and it's still active.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] The mailing address is [PII]. Is this correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. Can I get your fax number?
[AGENT][NEUTRAL] Fax number is [PII].
[CUSTOMER][NEUTRAL] To send the primary UP.
[CUSTOMER][NEUTRAL] Let me confirm the [PII]. Is this correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I don't have the one more patient. Uh, before that, can I get the turn on time to receive the fax?
[AGENT][NEUTRAL] 15 minutes.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] For the next patient? The last one.
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] The policy number is 02454119.
[AGENT][NEUTRAL] Repeat that for me.
[CUSTOMER][NEUTRAL] 02454119.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's first name is [PII] and the last name was [PII]. The date of birth is [PII].
[AGENT][NEUTRAL] What's the date of service for the claim?
[CUSTOMER][NEUTRAL] I'm looking for the data services.
[CUSTOMER][NEUTRAL] [PII] and the total charge amount is $490 490. And I have a specific question on this claim.
[AGENT][NEUTRAL] I'm not sure we have that claim on file.
[CUSTOMER][NEUTRAL] I have a claim number. Could you just check with that?
[AGENT][NEUTRAL] You have a claim number? What's the claim number?
[CUSTOMER][NEUTRAL] The claim number is 35824777.
[AGENT][NEUTRAL] OK, so what questions did you have about this claim?
[CUSTOMER][NEUTRAL] Actually, the claim has been delayed for the reason of non-covered charges. Can I get the details for the non-covered charges is under the patient plan or the provider's plan?
[AGENT][NEUTRAL] It's, um, not covered under the patient's policy.
[CUSTOMER][NEUTRAL] For what purpose the patient policy is not covered?
[CUSTOMER][NEUTRAL] Is this service is not covered or else?
[CUSTOMER][NEUTRAL] Is there any other different reason?
[AGENT][NEUTRAL] I'm sorry, what now?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Um, in what basis it is not covered as per the patient policy. It is not cover for the office visit or else it is?
[AGENT][NEGATIVE] It's not covered under the policy. It's not a covered it's not a covered benefit under the patient's policy. It's not covered under the patient's policy.
[CUSTOMER][NEUTRAL] OK, ma'am. The claim has been denied under the specific uh visa code of OA 96. Could you please uh submit to the PR 2 PR 96? Is that possible? Because under the patient's plans, we need the patient responsibility uh denial.
[AGENT][NEUTRAL] We're the gap insurance so we don't determine patient responsibility.
[CUSTOMER][NEUTRAL] Is that possible?
[CUSTOMER][NEUTRAL] OK. So the middle in cap, right?
[AGENT][NEUTRAL] Yes, we're not a major medical, we're the gap, so we don't determine patient responsibility.
[CUSTOMER][POSITIVE] OK, ma'am. Thank you so much for those providing this information. Can I get the members of Plan type?
[AGENT][NEUTRAL] It's a gap policy.
[CUSTOMER][NEUTRAL] Can I get the numbers of termination date?
[AGENT][NEUTRAL] Policy is effective [PII]. Policy term [PII].
[CUSTOMER][POSITIVE] OK, thanks so much for this information. Is there any other secondary insurance form for this patient? Could I have that information?
[AGENT][NEUTRAL] I don't have that information.
[CUSTOMER][POSITIVE] OK, ma'am. Thank you so much. And can I get a call number for this call?
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] No, ma'am. Thank you so much.
[AGENT][POSITIVE] Thank you for calling APO have a good day.
[CUSTOMER][POSITIVE] Thank you so much. Bye-bye.