AccountId: 011433970860
ContactId: ec286cce-dcc0-4d77-8b48-f64f7f5103c4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 613619 ms
Total Talk Time (AGENT): 117469 ms
Total Talk Time (CUSTOMER): 175088 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/ec286cce-dcc0-4d77-8b48-f64f7f5103c4_20250327T17:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling for provider's office to check on denial claim status.
[AGENT][NEUTRAL] OK, can you spell your first name for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]. OK, and you're checking claim status and what's the policy number and a good phone number for you?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII]. And it's a direct line?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And your name, please?
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It is 16257.
[AGENT][NEUTRAL] Mm, you have a copy of the card, [PII]. It's gonna be about 7 digits and it starts with a 0. It's gonna be the policy cert number.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Um, let me check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, one moment. Let me need to check that one.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, it's, it's gonna be 7, right? Um.
[CUSTOMER][NEUTRAL] I need to check the card. One moment. Uh.
[AGENT][NEUTRAL] Shoot
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh yes, thank you.
[CUSTOMER][NEUTRAL] 828 is the uh.
[CUSTOMER][NEUTRAL] One moment, but it's just opening it takes some time to open.
[AGENT][NEUTRAL] OK. No rush.
[CUSTOMER][POSITIVE] Yeah, thank you.
[CUSTOMER][NEUTRAL] Uh, could you please give me a second, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, just a moment. I'm still checking that one.
[AGENT][NEUTRAL] I can search it by the name [PII] you could spell the first and last name?
[CUSTOMER][NEUTRAL] Um, yeah, sure.
[CUSTOMER][NEUTRAL] Uh, patient name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK and I can search it by the name spell the name out for me.
[CUSTOMER][NEUTRAL] Sure. First name is [PII].
[CUSTOMER][NEUTRAL] And the last name is [PII]. It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And your name, please?
[AGENT][NEUTRAL] It's [PII] Sorry, you asked me that before.
[CUSTOMER][NEUTRAL] Mhm. Yes. OK. OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And is this for a medical claim?
[CUSTOMER][NEUTRAL] Yes, [PII]. Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you provide the, the date of birth of [PII]. OK, I have the policy number if you want to write it down.
[CUSTOMER][NEUTRAL] Hm, yes.
[AGENT][NEUTRAL] It's 228.
[AGENT][NEUTRAL] 4611.
[AGENT][NEUTRAL] And what is the date of service of the claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And the amount.
[CUSTOMER][NEUTRAL] $842 even.
[AGENT][NEUTRAL] OK, so it looks like the claim was denied as not covered. The office visit is not covered under the patient's policy. I'm showing a received date of [PII] and a processed date of [PII]. And let me know when you're ready for the claim number.
[CUSTOMER][NEUTRAL] you know for non-covered service under the patient plan, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So like uh office visit is like uh non-covered. OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Um, just, yeah, claim number.
[AGENT][NEUTRAL] The claim number is 350.
[AGENT][NEUTRAL] 389 8.
[CUSTOMER][NEUTRAL] OK, one moment. Um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That we need to check for the payment. Uh, actually, uh,
[CUSTOMER][NEUTRAL] Yes, you like the office is not covered, right? Non-covered by the patient plan. Uh, but actually on [PII], we do get a payment uh for the code 99214.
[AGENT][NEUTRAL] What's the claim number?
[CUSTOMER][NEUTRAL] Uh, that claim number is, it is one moment.
[CUSTOMER][NEUTRAL] OK, it's paid by the United Healthcare.
[CUSTOMER][NEUTRAL] Uh, one moment
[CUSTOMER][NEGATIVE] No, I couldn't see that claim got paid.
[CUSTOMER][NEUTRAL] But it's paid by the United Healthcare.
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] The CPT code 99214 uh procedure code it is paid by the United Healthcare.
[AGENT][NEUTRAL] OK, not American Public Life.
[CUSTOMER][NEUTRAL] Mm, no.
[AGENT][NEUTRAL] OK. All right. Did you have any other questions, [PII], I can help with today?
[CUSTOMER][NEUTRAL] Just a moment. Uh, just a reference number. So shall we bill the patient for this?
[AGENT][NEUTRAL] We do not determine patients responsibility and you'll use my name in today's date as reference for today's call.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So we are not supposed to be the patient.
[AGENT][NEUTRAL] We do not determine patients responsibility.
[CUSTOMER][NEUTRAL] Could you please repeat that, um,
[CUSTOMER][NEGATIVE] I couldn't get you.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Could you please repeat that?
[AGENT][NEUTRAL] OK, your voice went away.
[AGENT][NEUTRAL] So I can barely hear you.
[CUSTOMER][NEUTRAL] Um, yeah, can you hear me now?
[AGENT][NEUTRAL] That's a little better. We APL does not determine patients responsibility.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] OK. Uh, reference, reference number is like your name and uh today's date.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Uh, thank you, [PII]. I, I think I'm done and I don't have anything like.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Um, uh, yes, I think I'm done, uh, you.
[AGENT][NEUTRAL] I'm sorry, I didn't understand you, [PII]. What did you say?
[CUSTOMER][POSITIVE] No, I think I'm done. Uh, I don't have any claims to do, so thank you for your assistance, yeah. Yeah.
[AGENT][POSITIVE] Oh, OK. All right. You're welcome. Thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Have a nice day. Bye-bye.
[AGENT][NEUTRAL] Uh bye bye.