AccountId: 011433970860
ContactId: ecec40d9-9045-40b5-984d-363cafdce9da
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 322820 ms
Total Talk Time (AGENT): 101509 ms
Total Talk Time (CUSTOMER): 145453 ms
Interruptions: 10
Overall Sentiment: AGENT=1.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/ecec40d9-9045-40b5-984d-363cafdce9da_20250212T16:35_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][POSITIVE] Good morning. Thank you for calling ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] from Mount Sona Center. I'm calling about claim status.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the claim status, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, my callback number is [PII] is a direct line.
[AGENT][NEUTRAL] Thank you for that. And how many claims do you have in total today?
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] How many claims do you have in total today?
[CUSTOMER][NEUTRAL] How many clients do you have in total
[CUSTOMER][NEUTRAL] Uh, I have one claim.
[AGENT][NEUTRAL] OK, may I have the member's policy number?
[CUSTOMER][NEUTRAL] May I have the member's policy number
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It is um.
[CUSTOMER][NEUTRAL] 1449403 M as in mom.
[CUSTOMER][NEUTRAL] 4
[AGENT][NEUTRAL] And that was 1449403?
[CUSTOMER][NEUTRAL] And that was
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] and
[CUSTOMER][NEUTRAL] Yes, the member's name is [PII] and the date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. May I have the date of service for the claim you'd like me to check on?
[CUSTOMER][NEUTRAL] For that
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] May I have the
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] You said
[CUSTOMER][NEUTRAL] Yes,
[AGENT][NEUTRAL] And may I have the total bill?
[CUSTOMER][NEUTRAL] Um, give me a second. I'm, I'm just want to confirm.
[CUSTOMER][NEUTRAL] The total bill is $298.
[AGENT][POSITIVE] OK, take your time.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So we actually received the claim twice. Did you need both claim statuses or just the original?
[CUSTOMER][NEUTRAL] So we actually received the claim twice. Did you need both claim statuses or just the?
[CUSTOMER][NEUTRAL] Well, um, the denial is non covered charges, but, uh, I want to know more information about that.
[AGENT][NEUTRAL] OK, and what questions did you have and which claim number are you referencing to because we received it twice.
[CUSTOMER][NEUTRAL] OK, and what questions did you have and which claim number are you?
[CUSTOMER][NEUTRAL] Well, um,
[CUSTOMER][NEUTRAL] I have the claim number.
[CUSTOMER][NEUTRAL] OK, uh, let me confirm.
[CUSTOMER][NEUTRAL] I cannot see claim number here.
[AGENT][NEUTRAL] OK, um, so there's 2 claims we received it originally. Go ahead.
[CUSTOMER][NEUTRAL] OK, um, so there's 2 planes.
[CUSTOMER][NEUTRAL] Mhm, yeah, this is not the the originally.
[AGENT][NEUTRAL] OK, so this is the 2nd claim from December?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, they were denied for the same reason. Um, it's not covered when performed in a doctor's office or clinic, and what questions did you have?
[CUSTOMER][NEUTRAL] Performed at a doctor's office at the clinic and what questions
[CUSTOMER][NEUTRAL] OK, you do not because?
[AGENT][NEUTRAL] The claim was denied because the service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEGATIVE] The claim was denied because the service.
[CUSTOMER][NEUTRAL] Covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um, we need to send this bill directly um the.
[CUSTOMER][NEUTRAL] The patient
[AGENT][NEUTRAL] Well, we don't determine patient responsibility. So, um, if whatever the policy is for outstanding balances, that would be between primary and you as the provider.
[CUSTOMER][NEUTRAL] Well, we don't determine patient responsibility, so um it's.
[CUSTOMER][NEUTRAL] Whatever the policy is for outstanding balances, that would be the same primary.
[CUSTOMER][POSITIVE] OK, I understand, thank you so much for confirming.
[AGENT][POSITIVE] You're very welcome. Was there anything, go ahead.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So, uh, the previous claim was denied, um, for the same reason, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, thank you so much and do you have a reference number for this call just for no.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] So there's no call reference number, but you can use my name in today's date.
[CUSTOMER][POSITIVE] [PII], OK, thank you so much. Have a great day.
[AGENT][POSITIVE] You're welcome, [PII]. You also, and thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Welcome [PII]
[CUSTOMER][NEUTRAL] Call