AccountId: 011433970860
ContactId: e8a2cfe7-8d7c-42fc-9579-9de731bd5c0e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 667859 ms
Total Talk Time (AGENT): 159818 ms
Total Talk Time (CUSTOMER): 176698 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/e8a2cfe7-8d7c-42fc-9579-9de731bd5c0e_20250102T20:16_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office to check on a claim status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status, [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, member ID is one moment it's loading.
[CUSTOMER][NEUTRAL] And before that, could you spell your name please for documentation purpose?
[AGENT][NEUTRAL] My name is [PII]. That's [PII]. Last initial is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you, so.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Member ID is 02.
[CUSTOMER][NEUTRAL] 1377.
[CUSTOMER][NEUTRAL] 79.
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Global
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] date of birth [PII].
[AGENT][NEUTRAL] OK. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Yes, date of service [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] The total bill amount would be.
[CUSTOMER][NEUTRAL] $100 even.
[AGENT][NEUTRAL] OK, so that's [PII] for $100. Is that correct?
[CUSTOMER][POSITIVE] Mhm correct.
[AGENT][NEUTRAL] OK, let me see if I can find this claim. For future, you can check claim status online through our website at [PII] and that's just optional. And let's see.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it looks like we have processed the claim twice. Um, the most recent one is a duplicate and then the original one was processed and denied office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, offices are not covered by the policy, but
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And whether it was under patient plan or provider plan.
[AGENT][NEUTRAL] Patients plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you, sir. Thank you for your patience. May I know the claim number, please?
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Sure. Original. OK, the original is 3284968.
[CUSTOMER][NEUTRAL] Uh, original claim number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, may I know the receipt date of the claim?
[AGENT][NEUTRAL] OK, let me get the receipt date of the original, one moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it was received [PII], process [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, one moment, [PII].
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Of [PII].
[CUSTOMER][NEUTRAL] And process.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and does not.
[CUSTOMER][NEUTRAL] Award
[CUSTOMER][NEUTRAL] OK, as office visits are not covered under patient plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, may I know the patient plan?
[AGENT][NEUTRAL] Um, this is a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Veterinary policy.
[CUSTOMER][NEUTRAL] Hello is this Emo.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's through their employer, but it's a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, thank you so thank you for your assistance and your call reference number please.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] Mhm and I do have a.
[CUSTOMER][NEUTRAL] Two more claims for the same patient but different date of service. Could you please help me to check that also?
[AGENT][NEUTRAL] Oh, sure. What is the next state of service?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, thank you so much. The next date of service [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And how much is that one for?
[CUSTOMER][NEUTRAL] Yes, total bill amount would be.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] One moment, it's loading.
[AGENT][NEUTRAL] Mhm. Sure.
[CUSTOMER][NEUTRAL] $100 even.
[AGENT][NEUTRAL] OK, so this one was denied with the same reason.
[AGENT][NEUTRAL] Um, the claim number on this one is 3321513.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And could you please repeat the claim number?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 33
[AGENT][NEUTRAL] 332.
[AGENT][NEUTRAL] 1513.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much. May I know the receipt date of this claim?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it was received on [PII], processed on [PII].
[CUSTOMER][NEUTRAL] [PII], the year, right? The same. OK, OK, thank you so much. OK, yes, uh, let, let us move to the next state of service.
[AGENT][NEUTRAL] Correct. Correct. [PII]. Mhm mhm.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] Next date of service [PII].
[AGENT][NEUTRAL] How much is that one for?
[CUSTOMER][NEUTRAL] Uh yes, one moment, it's loading.
[CUSTOMER][NEUTRAL] Total bill amount $140 even.
[AGENT][NEGATIVE] OK. So it's gonna be denial with the same denial reason.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And we have um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim number 3,455,420.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Receive [PII], process [PII].
[CUSTOMER][NEUTRAL] OK, uh, for the same denial reason?
[AGENT][NEGATIVE] Yes, the same denial.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, thank you. So thank you for your assistance call reference would be your name and today's date, right?
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][POSITIVE] Mhm. Yes, thank you. So thank you for your assistance. Have a wonderful day.
[AGENT][POSITIVE] You as well. Thank you for calling AP on this lovely.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You too bye for now.