AccountId: 011433970860
ContactId: f8877292-de66-427d-9559-6f5365eb0942
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 380010 ms
Total Talk Time (AGENT): 97919 ms
Total Talk Time (CUSTOMER): 106085 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/f8877292-de66-427d-9559-6f5365eb0942_20250127T17:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, sir, uh, this is [PII] calling from provider office to check claim status and before we proceed, I want to inform you this call will be recorded for quality and training purposes. Is that OK for you?
[AGENT][POSITIVE] OK. I'm happy to check on a claim for you today. What is the patient's policy number?
[CUSTOMER][NEUTRAL] Sure. It's 02115936.
[AGENT][NEUTRAL] All right, thank you for that. And if I can have patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you for that and date of service?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[AGENT][NEUTRAL] Fill them out.
[CUSTOMER][NEUTRAL] It's $286 even.
[AGENT][POSITIVE] All right, thank you for that one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you for your patience and waiting on that. So we did receive this claim [PII].
[AGENT][NEUTRAL] Uh, claim was denied.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, the charges incurred were not covered at an independent facility, only covered in a hospital or outpatient surgery center.
[CUSTOMER][NEUTRAL] Sorry, can you repeat once again why it was not covered?
[AGENT][NEUTRAL] The charges incurred.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] are not covered.
[AGENT][NEUTRAL] At an independent lab.
[CUSTOMER][NEUTRAL] OK, it was provided in the lab. That's why it was not covered, correct?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK, so just a moment.
[CUSTOMER][NEUTRAL] Is uh this is as per patient plan or uh provider contract?
[AGENT][NEUTRAL] For the, for the patient plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is the plan name of patient?
[AGENT][NEUTRAL] It's a meddling plan.
[CUSTOMER][NEUTRAL] Patient uh plan name.
[AGENT][NEUTRAL] Medin, it's a secondary insurance.
[CUSTOMER][NEUTRAL] OK, Mad Mad link plan. OK, sure.
[CUSTOMER][NEUTRAL] And what is the claim number?
[AGENT][NEUTRAL] 351.
[AGENT][NEUTRAL] 685 4.
[CUSTOMER][NEUTRAL] OK, it's 351-685-4, correct?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK, and I have one more claim after this claim and what is call reference for this one?
[AGENT][NEUTRAL] Call reference would be my name with my last initial and today's date. My name again is [PII], that's [PII]
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Last initial to my name is [PII].
[CUSTOMER][NEUTRAL] OK, sure. Just a moment.
[AGENT][NEUTRAL] What's the next policy number?
[CUSTOMER][NEUTRAL] So just a moment.
[CUSTOMER][NEUTRAL] Yes, uh, policy number is 01774089 M as in Mike L as in Lima 7.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and then what is the date of service?
[CUSTOMER][NEUTRAL] D of service is [PII] and bill amount is $212 even.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] We received this claim [PII].
[AGENT][NEUTRAL] Are the clients denied we need explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] OK. And what is your fax number?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and what is the claim number?
[AGENT][NEUTRAL] 349.
[AGENT][NEUTRAL] 334 1.
[CUSTOMER][NEUTRAL] OK sure.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK, uh, and thank you so much for your assistance, [PII], and have a great day and bye for now.
[AGENT][NEUTRAL] You too bye bye.