AccountId: 011433970860
ContactId: fb8938b7-dc4c-441c-99c4-3625c631d541
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 452149 ms
Total Talk Time (AGENT): 111962 ms
Total Talk Time (CUSTOMER): 69798 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/fb8938b7-dc4c-441c-99c4-3625c631d541_20250117T21:18_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] Sorry, can you spell your first name for me?
[AGENT][NEUTRAL] [PII]. Last initial [PII].
[CUSTOMER][NEUTRAL] Thank you for that. My name is [PII], and I'm calling on behalf of Nova Health. I'm calling to obtain claim status for a patient.
[AGENT][NEUTRAL] Sure, I can assist you with claim status, Miss [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 01622962 ML 8.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII]. And date of birth is [PII].
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Thank you. And may I have um the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] For $327.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Let me see if I can find this claim. And for future, you can check claim status online through our website at [PII], and that's just optional.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me pull this EOB. Let me see if this is yours. One moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Oh no that's not it.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] Um, let me try this. What is the procedure code?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Do you have the procedure codes?
[CUSTOMER][NEUTRAL] The procedure code.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I have decision.
[CUSTOMER][NEUTRAL] I have 99214.
[CUSTOMER][NEUTRAL] And I also have G 2211.
[AGENT][NEUTRAL] Got it.
[AGENT][NEUTRAL] Alright, so it looks like we processed the claim on [PII] and the claim was denied. The reason for this denial is that office visits are not covered by the policy, and this service is not covered in the office.
[CUSTOMER][NEUTRAL] Alright, thanks for that. Is there an EOB on file?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, and the the claim number is 3406892.
[AGENT][NEUTRAL] Do you need me to fax a copy?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, what is the fax number?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK. So your attention is OK.
[CUSTOMER][POSITIVE] Yes, that'll be great.
[AGENT][NEUTRAL] All right. Do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][POSITIVE] Yes, that'll be great.
[AGENT][NEUTRAL] OK, one moment. I'm gonna put you on a brief hold so I can send this out to you right now. OK, 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.
[AGENT][POSITIVE] Thank you for holding and being patient for you Miss. [PII]. OK, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] No, that'll be all. Thank you and have a great weekend.
[AGENT][POSITIVE] You're welcome. You as well, and thank you for calling APM. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.