AccountId: 011433970860
ContactId: f8b68131-0227-4d99-b735-c866084bd248
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 729669 ms
Total Talk Time (AGENT): 130086 ms
Total Talk Time (CUSTOMER): 101169 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/f8b68131-0227-4d99-b735-c866084bd248_20250321T18:35_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, this is [PII] calling from the Lucian Healthcare Associate.
[AGENT][NEUTRAL] And how may I assist you today, Mr. [PII]?
[CUSTOMER][NEUTRAL] Mm, to verify the claim denied.
[AGENT][NEUTRAL] OK, sure, I can assist you with claims. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII] is a direct line?
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Um, member's ID would be 01739515.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh, member's name would be [PII], and the date of birth is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. What's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of service would be [PII] with the total charge amount of $390.09.
[AGENT][NEUTRAL] OK, sure. Let me see if I can find this claim for you and that was [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] $100.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Is it a range of date or is it just a single date?
[AGENT][NEUTRAL] Mr. [PII].
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello Mr. [PII]. Yes, is this for?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Uh, is it for [PII]?
[AGENT][NEUTRAL] [PII], so it's just a single day.
[CUSTOMER][NEUTRAL] Uh, could you please uh check for amount $140?
[AGENT][NEUTRAL] I don't have a claim for [PII].
[CUSTOMER][NEUTRAL] Uh, I have claim number.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] 353-553-3
[AGENT][NEUTRAL] OK, let me pull the details on that claim. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Honestly.
[AGENT][NEUTRAL] It's totally different policy, bear with me.
[CUSTOMER][POSITIVE] Mhm. Sure, take your time.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] OK, he has his own policy. You see the number on the explanation of benefits, the reference number, that's his policy number. That's a different policy number, OK?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] That's why I was not able to find it under this other policy. But this one is stating that office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] So we will, we will transfer the remaining balance to patient bucket.
[AGENT][NEUTRAL] It's up to the provider discretion. We don't have any contractual involvement on the remaining.
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] And thank you so much for providing the information. And could you please help me with the one more claim for the same patient under the different member ID?
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, what is the um members ID?
[CUSTOMER][NEUTRAL] 26
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 02462081.
[AGENT][POSITIVE] OK, this is the correct one.
[AGENT][NEUTRAL] OK, and what is the date of service?
[CUSTOMER][NEUTRAL] D of service would be [PII].
[CUSTOMER][NEUTRAL] Uh, for the total charge amount of $120.
[AGENT][NEUTRAL] OK, so this one was also denied as office visits are not covered by the policy.
[AGENT][NEUTRAL] You need the claim number?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim number on this one is 3543632.
[CUSTOMER][NEUTRAL] We do
[CUSTOMER][NEUTRAL] And could you please fax the EOP?
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] your attention, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] How do you spell the name just to make sure I spell it correctly.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Thank you. Do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] Mm-hmm sure.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for me, Mr. [PII]. I went ahead and send that to you. It should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] Uh, no, thank you for asking.
[AGENT][POSITIVE] You're welcome and thank you for calling ATL. Have a good afternoon, Mr. [PII].
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Mhm, go ahead.
[AGENT][NEUTRAL] Go ahead, Mr. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Uh, no, that's all. Thank you for asking. Have a great day.
[AGENT][NEUTRAL] You as well bye bye.
[CUSTOMER][NEUTRAL] Bye.