AccountId: 011433970860
ContactId: ff25b59c-344c-4b47-ab02-545e3ab9030f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 368359 ms
Total Talk Time (AGENT): 79391 ms
Total Talk Time (CUSTOMER): 80790 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/ff25b59c-344c-4b47-ab02-545e3ab9030f_20250613T19:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, my name's [PII]. I'm calling from AMHealth, and I have two claims I need to check on for a patient.
[AGENT][NEUTRAL] And you said you're calling from Admin?
[CUSTOMER][NEUTRAL] And [PII]
[AGENT][NEUTRAL] And can I get a good call back number in case we get disconnected [PII]?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] Oh, let's see, I have it right here. It is 02351156.
[AGENT][NEUTRAL] OK, give me just a moment to pull that up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] Yes, it is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Great, thank you so much for verifying that with me.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] I don't have a claim number. I have data service 92624.
[CUSTOMER][NEUTRAL] For $234.
[CUSTOMER][NEUTRAL] And he has one more claim.
[AGENT][NEUTRAL] Alright, let me look at this one first and then I'll get to the 2nd 1.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said it was for $234 correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Alright, it looks like that claim was denied.
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] It looks like a laboratory tests aren't covered, aren't a covered benefit under the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And did you, did you need the claim number for that?
[CUSTOMER][NEUTRAL] Yes, I'll take it. I'm not sure we have an EOB on that, but OK, claim number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 3,521,440.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you want me to fax you an EOB?
[CUSTOMER][NEUTRAL] I'm gonna look for uh yeah let me look for it right quick while you check his other claim if you don't mind.
[AGENT][NEUTRAL] What's the other date of service?
[CUSTOMER][NEUTRAL] Are
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And the total bill amount?
[CUSTOMER][NEUTRAL] For $400.
[AGENT][NEUTRAL] All right, I'll go ahead and look up that one while you look for the EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Right, and it looks like the uh second claim was also denied uh due to the laboratory tests um performed to diagnose or for the treatment of an illness are not covered, um, except when performed in a physician's office.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] OK, and I'm sorry, I did, I do have the EOBs for both of those, uh, I hate that I wasted your time.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][POSITIVE] OK, thank you so much for your help.
[AGENT][POSITIVE] Great, thank you for calling [PII]. I hope you have a great weekend.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye.