AccountId: 011433970860
ContactId: dd3f62ff-1109-43e2-89d6-7fb6620dbf64
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 514739 ms
Total Talk Time (AGENT): 121532 ms
Total Talk Time (CUSTOMER): 121363 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/dd3f62ff-1109-43e2-89d6-7fb6620dbf64_20250318T16:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hello [PII]. My name is [PII]. I'm calling from Center Medical Group and I need to inquire on a claim.
[AGENT][NEUTRAL] OK, Ms. [PII], I can help you with the claim. And you said you were calling from Century Medical Group?
[CUSTOMER][NEUTRAL] No, Fentera Medical Group.
[AGENT][POSITIVE] Centera. OK, thank you, ma'am.
[CUSTOMER][NEUTRAL] Yes, ma'am. Uh-huh.
[AGENT][NEUTRAL] And then what is your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And can I please get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yes, [PII], [PII] policy number 02287977.
[AGENT][POSITIVE] Thank you. Let me go ahead and pull that policy up real quick.
[AGENT][NEUTRAL] OK, thank you and then what is the date of service and the charge amount?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes, I have a data service as um let's see, [PII] total charge amount $415.
[AGENT][NEUTRAL] And then what is the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Yes, oh well, after the primary paid their part, it was a a balance of $35 left over.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Put you on a quick hold on you while I look up this claim for you and I will be right back.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding for me, [PII]. So looking at data service of [PII], I do not find a claim on file for the uh facility that you have given me.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK. Oh, OK, I'm sorry, I'm calling from Centera Medical Group, but Centerum off for Jefferson Medical Group, but the service and facility is Centera Spring Creek Family.
[AGENT][NEUTRAL] Got you. OK, so it's under Martha Jefferson Medical Group that you just mentioned. OK. No, that's fine. And um the claim was denied because.
[CUSTOMER][POSITIVE] Oh, OK. I'm sorry.
[AGENT][NEUTRAL] Uh, policy provides no benefits for treatment of conditions other than sickness or injury.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So this policy only covers.
[CUSTOMER][NEGATIVE] Sickness and injury only.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm, so how do y'all to determine that by the diagnosis code or something?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, because the diagnosis, um, you said pain in right arm pain in left arm.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Now, if you want
[CUSTOMER][NEUTRAL] That's not uh in uh huh.
[AGENT][NEUTRAL] Yeah, it's, um, all I can do is just give how the claim was filed. It also has another remark on there that office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Got you. OK. OK.
[CUSTOMER][NEUTRAL] Alright, office visit is not covered by the policy. OK, alright, how do I get, how do I, how do, how do I get a copy of the um EOB?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] I can send that to you. Can I get your fax number?
[CUSTOMER][NEUTRAL] Yes ma'am, it's going to be 757.
[CUSTOMER][NEUTRAL] 431-715-4.
[CUSTOMER][NEUTRAL] And that's attention [PII]
[AGENT][NEUTRAL] [PII] OK, I'm gonna put you on a quick hold while I get that faxed over to you and I will be right back.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Oh great, right, OK, great. Well I'm on the phone, that's even better. Thank you.
[AGENT][POSITIVE] All right. Yes, ma'am. You're welcome.
[CUSTOMER][NEUTRAL] Mhm. You are on hold.
[AGENT][NEUTRAL] Come on.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, Ms. [PII], I've got that on its way to you right now.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, thank you so much. And uh can I get the spelling of your name?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] Why, OK, call reference number?
[AGENT][NEUTRAL] My name and today's date?
[CUSTOMER][POSITIVE] Got you thank you so much for your time and your help. I really do appreciate you and have a great day.
[AGENT][NEUTRAL] You too, Miss [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][POSITIVE] No, ma'am, thank you so much.
[AGENT][POSITIVE] Alright, well, you have a wonderful day too, and I appreciate you calling APL today.
[CUSTOMER][POSITIVE] OK, thank you, bye bye.
[AGENT][NEUTRAL] Bye-bye.