AccountId: 011433970860
ContactId: f8bb6d4b-303e-4f5e-8292-bd2e4472b586
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 369920 ms
Total Talk Time (AGENT): 123807 ms
Total Talk Time (CUSTOMER): 111083 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/f8bb6d4b-303e-4f5e-8292-bd2e4472b586_20250129T16:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Medical in the City Hospital to check claim status. How are you doing?
[AGENT][POSITIVE] I'm doing well, [PII]. How are you doing today?
[CUSTOMER][POSITIVE] Yeah, I'm doing good.
[AGENT][NEUTRAL] Good. And what is the callback number if we are disconnected please?
[CUSTOMER][NEUTRAL] Callback number is [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you. And what is that policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The policy number is uh.
[CUSTOMER][NEUTRAL] 023893887.
[AGENT][NEUTRAL] OK. And to repeat and confirm, I have that as 023893887.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] There, thank you, verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you so much for the verification process. Again, you call for claims status. I can assist you with that. Excuse me. What's the date of service and bill amount please for the member.
[CUSTOMER][NEUTRAL] Data services [PII] and total charge amount for the claim is $106 even.
[AGENT][NEUTRAL] OK. And to repeat that month, [PII] $106 even. Thank you.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you. And also, [PII], you're able to check claim status by visiting our secure portal at [PII] providers can also obtain any leads from that website as well. Now I do not show that we have that claim on file.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What was the claim uh status?
[CUSTOMER][NEUTRAL] So do I pay?
[AGENT][NEUTRAL] We
[AGENT][NEUTRAL] We do not have the claim on file.
[CUSTOMER][NEUTRAL] But uh previous call they verified the.
[CUSTOMER][NEUTRAL] Uh, OK.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Yeah, sure. On in previous uh previous call, we collected the claim information and I do have the claim number. Shall I say that? Could you check for me?
[AGENT][NEUTRAL] I sure can.
[CUSTOMER][NEUTRAL] Yes. The claim number is 352.
[CUSTOMER][NEUTRAL] 9945.
[AGENT][NEUTRAL] OK, so that's [PII], not [PII], is that correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so the day of service is [PII].
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Now in regards to the particular claim number that you provided me 352-9945, it shows that that claim was denied as a non-covered service.
[CUSTOMER][NEUTRAL] Well that's the one.
[AGENT][NEUTRAL] I'm so sorry, I cannot understand, [PII].
[CUSTOMER][NEGATIVE] Uh, why it has been denied us, uh, non-core services.
[AGENT][NEUTRAL] Because of the place of service, this is a non-covered service for the patient's plan.
[AGENT][NEUTRAL] And APL does not determine patient's responsibility.
[CUSTOMER][NEUTRAL] Yeah, OK, could you provide me a copy of you before this claim?
[AGENT][NEUTRAL] Um, ELBs are available on the website at [PII].
[CUSTOMER][NEGATIVE] Yeah, we are unable to pulling up the you that's why we made a call.
[AGENT][NEUTRAL] What is your fax number I can fax this one over to you as a courtesy.
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII].
[AGENT][NEUTRAL] And to confirm that, I have it as [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Anything else I can help you with, [PII]?
[CUSTOMER][NEUTRAL] OK. And uh I do have another claim for this, uh.
[CUSTOMER][NEUTRAL] In the same member ID for the different patient.
[CUSTOMER][NEUTRAL] But that's also I need a copy of UOB.
[AGENT][NEUTRAL] OK, what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is uh Madam [PII] and date of birth is [PII].
[AGENT][NEUTRAL] And what is that claim number?
[CUSTOMER][NEUTRAL] Yeah. The claim number is uh
[CUSTOMER][NEUTRAL] 352-877-1.
[AGENT][POSITIVE] Alright, thank you. It shows it was non-covered service as well. OK, I can fax this over as well for you. Anything else I can help you with?
[CUSTOMER][NEUTRAL] Yeah, OK, could you provide me call the number, uh, call in.
[AGENT][NEUTRAL] We do not provide a call reference numbers, [PII]. You can use my name, [PII], last initial [PII], and today's date.
[CUSTOMER][POSITIVE] OK. Thanks for your assistance and patience. Have a great day.
[AGENT][POSITIVE] You as well, [PII] and thank you for calling APL. Take care bye.
[CUSTOMER][NEUTRAL] Bye-bye.