AccountId: 011433970860
ContactId: d269ffea-9d8d-4aca-b129-6d2957c34a90
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 414799 ms
Total Talk Time (AGENT): 97777 ms
Total Talk Time (CUSTOMER): 109141 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/d269ffea-9d8d-4aca-b129-6d2957c34a90_20250130T14:16_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Protosurface to check on claim status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yep [PII].
[CUSTOMER][NEUTRAL] Direct line.
[AGENT][NEUTRAL] And you're calling from which facility or provider for my notations.
[CUSTOMER][NEUTRAL] Marian General Hospital.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yup. D as in Delta, 476-02735.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you see any other policy numbers? It's gonna start with a 0 followed by 7 digits, no letters in the beginning.
[CUSTOMER][NEUTRAL] Um, no.
[CUSTOMER][NEUTRAL] Or else, could you please first the patient with name and details for.
[AGENT][NEUTRAL] Oh sure.
[AGENT][NEUTRAL] OK. And what is the spelling of the first name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] That's the first name or last name?
[CUSTOMER][NEUTRAL] And the last name?
[CUSTOMER][NEUTRAL] The first name, [PII] and the last name is gonna be [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm mm mm mm.
[CUSTOMER][NEUTRAL] I'm.
[AGENT][NEUTRAL] And what is his date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] May I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The date of service is gonna be [PII].
[CUSTOMER][NEUTRAL] And the total bill amount, $373 even.
[AGENT][NEUTRAL] OK, [PII] for 373.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Ja the claim status.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mm mm mm mm.
[AGENT][NEUTRAL] OK, um, the claim is not on file for that date of service [PII].
[CUSTOMER][NEUTRAL] But I do have a claim number for that.
[AGENT][NEUTRAL] Go ahead with the claim number.
[CUSTOMER][NEUTRAL] 3210461.
[AGENT][NEUTRAL] OK, let me go to a different policy, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] I'm waiting on the image.
[CUSTOMER][POSITIVE] Cheer on
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] I'm on.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so this one was the nice stating that it's not a covered service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Not comfortable.
[CUSTOMER][NEUTRAL] So the procedure code is not covered or else the DX is not covered, uh.
[CUSTOMER][NEUTRAL] No no no.
[AGENT][NEUTRAL] OK, the denial reason indicates the diag diagnostic testing is not covered. We only cover MRI, CT scan, thyroid intake, um.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, may I know the claim receive date for this claim?
[AGENT][NEUTRAL] GI series sleep study.
[AGENT][NEUTRAL] OK, let me see when it was received. One moment.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, it was received [PII] process [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm mm mm mm mm mm mm mm.
[CUSTOMER][NEUTRAL] OK, may I know the call reference number for this call?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's state if you will.
[CUSTOMER][NEUTRAL] Could you please spell your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] Thank you for your decision and patience. Have a nice day.
[AGENT][NEUTRAL] You're welcome. Thank you for calling PO. Bye bye, Mr.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Mhm