AccountId: 011433970860
ContactId: e21afecf-8696-48a7-b73e-e7f337d1edab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 401720 ms
Total Talk Time (AGENT): 147478 ms
Total Talk Time (CUSTOMER): 195267 ms
Interruptions: 2
Overall Sentiment: AGENT=1.6, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/e21afecf-8696-48a7-b73e-e7f337d1edab_20250404T15:10_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] Like
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. This is [PII], and I'm calling for Florida Women Care to check on additional information about the claim that has been denied. Please note this call will be monitored and recorded for quality and training purposes.
[AGENT][POSITIVE] Well, [PII], it would be my pleasure to assist you with claim information. What is a good call back number?
[CUSTOMER][NEUTRAL] Callback is [PII].
[CUSTOMER][NEUTRAL] like all the.
[AGENT][NEUTRAL] Thank you, and [PII], what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] That will be 01545923 M as in Mike Lima number 8.
[AGENT][NEUTRAL] Thank you. And do you happen to have that claim number, [PII]?
[CUSTOMER][NEUTRAL] Um, yes, one moment, let me pull up that.
[CUSTOMER][NEUTRAL] Let me check, uh.
[CUSTOMER][NEUTRAL] Yes, um, claim number I have, uh, received in the correspondence is 357722-3.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And do you mind verifying the date of service and bill amount?
[CUSTOMER][NEUTRAL] Um, yeah, definitely, one second.
[AGENT][NEUTRAL] And I'll need the patient's name and date of birth.
[CUSTOMER][NEUTRAL] You don't.
[CUSTOMER][NEUTRAL] Uh yeah, sure. The patient's full name is [PII]. Date of birth is [PII]. Date of birth for this claim would be [PII]. Total bill amount is $44,500 even.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I have the original claim pulled up.
[AGENT][NEGATIVE] And the original claim we received on 2-10-25 and processed on 2-11-25 and it was denied as services are not covered when performed in a doctor's office.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. So it is non-covered as a patient's plan or providers contract?
[AGENT][NEUTRAL] Patients plan.
[CUSTOMER][POSITIVE] Perfect. Thank you. Can I get the call reference number for this patient [PII]?
[AGENT][NEUTRAL] Would you, would you like the original claim number?
[CUSTOMER][POSITIVE] Uh, yeah, that will be very helpful. Thank you.
[AGENT][NEUTRAL] Yes, ma'am. The original claim number is 356.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 2294.
[CUSTOMER][NEUTRAL] 4. OK. And the recent one was received and denied on?
[AGENT][NEUTRAL] It was received the original one?
[AGENT][NEUTRAL] Received on 2.
[CUSTOMER][NEUTRAL] Uh, no, Dina.
[AGENT][NEUTRAL] Uh, the denial, the duplicate claim.
[AGENT][NEUTRAL] The the claim number 357-722-3 was received on.
[CUSTOMER][NEUTRAL] Yeah, the next one.
[AGENT][NEUTRAL] 3 1425 and processed on 3 1825.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so this claim, this, uh, then, um, the another claim was denied for duplicate.
[AGENT][NEUTRAL] The original claim was denied due to services not covered in the doctor's office. The 357-722-3 claim was denied as a duplicate.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Perfect. Thank you. And uh can you help me with the call reference for this claim I issue?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] The call reference number is my name and today's date, and I spell my name [PII], it was a pleasure to assist you with that claim information. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Um, yes, [PII]. Thank you so much for that. And uh also I have one more patient to check, so is it possible to assist me with that?
[AGENT][POSITIVE] It would be my pleasure, [PII]. What is that policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] One moment, let me pull up that here. Give me a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] This is just
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thank you so much for patiently being on hold. The next member ID I have here is
[CUSTOMER][NEUTRAL] Mm one moment.
[AGENT][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] Let me see. Thank you. And yeah, here it is. It's um 01896415.
[AGENT][NEUTRAL] And [PII], what is that patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] His full name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you and do you have that claim number or date of service?
[CUSTOMER][NEUTRAL] Uh, yeah, I have the claim number as 3577512.
[AGENT][NEUTRAL] And that date of service and build amount, please.
[CUSTOMER][NEUTRAL] Date of service for this claim will be [PII], and total charge amount is $730 even.
[AGENT][NEUTRAL] And this is for a different provider. What is the facility name?
[CUSTOMER][NEUTRAL] Facility name here is Ortho Lone Star.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] And send that claim we received.
[CUSTOMER][NEUTRAL] What kind of
[AGENT][NEUTRAL] On [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Processed on [PII].
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] And this was denied as office visits are not covered and that is per the patient's plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect plan. Perfect. Thank you. And uh the reference number would be your name and to the state, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK, perfect. Thank you so much, [PII], and I appreciate your time. Thank you so much again and uh have a lovely weekend. Thank you.
[AGENT][POSITIVE] I hope you have a lovely weekend as well. It was my pleasure to assist you with that claim status and anything else before you go, [PII]?
[CUSTOMER][POSITIVE] Uh, no, that's it from my side. Thank you so much again.
[AGENT][POSITIVE] Thank you for calling APL. You take care.
[CUSTOMER][POSITIVE] Yeah, take care. Bye-bye.
[AGENT][NEUTRAL] Bye bye.