AccountId: 011433970860
ContactId: d1d6ae73-8bf8-4734-8026-2631c22c6f08
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 218580 ms
Total Talk Time (AGENT): 76397 ms
Total Talk Time (CUSTOMER): 86153 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/d1d6ae73-8bf8-4734-8026-2631c22c6f08_20250124T17:54_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from provider's office. I wanna check on claims denial reason.
[AGENT][POSITIVE] Well, [PII], it would be my pleasure to assist you with that claim claim denial. What is a good callback number?
[CUSTOMER][NEUTRAL] It would be [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] It would be 022.
[CUSTOMER][NEUTRAL] 838
[CUSTOMER][NEUTRAL] 44
[CUSTOMER][NEUTRAL] Letter M as in Mike, L as in Lima, and then number 8.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the patient's name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] Yes, sure. The first name would be [PII], the last name would be
[CUSTOMER][NEUTRAL] The Casino and the date of birth of the patient is going to be [PII].
[AGENT][NEUTRAL] Thank you. And do you happen to have that claim number?
[CUSTOMER][NEUTRAL] [PII]. Yeah.
[CUSTOMER][NEUTRAL] I do have the claim number. It would be 353.
[CUSTOMER][NEUTRAL] 3305.
[AGENT][NEUTRAL] And do you mind verifying the date of service build amount and facility name?
[CUSTOMER][NEUTRAL] Yeah, sure. The date of service is on [PII].
[CUSTOMER][NEUTRAL] For the amount of $1,211 even.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And the providers.
[AGENT][NEUTRAL] And the facility name.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] It would be Pediatrics Medical Group of Florida.
[AGENT][NEUTRAL] All right, and it would be my pleasure to assist you with that denial reason for this claim. Now, [PII], per the guidelines of the policy, office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And shall we bill the patient for the service?
[AGENT][NEUTRAL] And that would be determined by the provider. APL does not determine patient responsibility.
[CUSTOMER][NEUTRAL] OK, got that.
[CUSTOMER][NEUTRAL] Thank you so much for that information. I just want to confirm if the patient has any out of network benefits.
[AGENT][NEUTRAL] It's not with APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for all this information. Can I get the call reference number, please?
[AGENT][NEUTRAL] The call reference number is my name and today's date, and I spell my name, [PII]
[AGENT][NEUTRAL] First initial and my last name is [PII].
[AGENT][POSITIVE] And thank you for calling APL [PII], it was a pleasure to assist you with that claim denial.
[CUSTOMER][NEUTRAL] Got the deli.
[CUSTOMER][POSITIVE] Thank you so much for your wonderful assistance, [PII]. Have a great day.
[AGENT][POSITIVE] It's my pleasure and thank you for calling APL Sarah. Happy weekend to you.
[CUSTOMER][POSITIVE] Thank you. You too, [PII]. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Yeah.