AccountId: 011433970860
ContactId: 036964a0-7852-4062-a981-ac53c531d51f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 333119 ms
Total Talk Time (AGENT): 101755 ms
Total Talk Time (CUSTOMER): 106164 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/036964a0-7852-4062-a981-ac53c531d51f_20250523T19:29_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, my first name is [PII], my last name is [PII] calling you from the provider's office looking for claim status.
[AGENT][NEUTRAL] All right, [PII]. Happy to check on a claim. Can I get the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, yes, the patient's ID is uh.
[CUSTOMER][NEUTRAL] 04, I'm sorry, D as in Delta 43700506.
[AGENT][NEUTRAL] Thank you [PII]. Unfortunately I can't pull the number with that number. Do you have their card? Do you see any sort of like certificate number?
[CUSTOMER][NEUTRAL] OK, I just hold on.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, so the member's ID is 0248.
[CUSTOMER][NEUTRAL] 6182.
[AGENT][NEUTRAL] OK, let me pull that up here. One moment.
[AGENT][NEUTRAL] And then if I could please have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's first name is uh [PII]. Last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] All right, thank you for that. And then what is the date of service?
[CUSTOMER][NEUTRAL] Uh, [PII] total charge is $730 a year.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Thank you for your patience on that, [PII]. So it looks like we did receive a claim for the state of service. The claim was received on [PII].
[AGENT][NEUTRAL] Claim is processed and denied [PII] as well. The medical test for this state of service is not a covered benefit.
[CUSTOMER][NEUTRAL] OK, so is it not covered under the patient's plan or providers?
[AGENT][NEUTRAL] Uh, under the patient's plan.
[CUSTOMER][NEUTRAL] And the uh claim number.
[AGENT][NEUTRAL] Is 352.
[AGENT][NEUTRAL] 572 8.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the reference number for this patient.
[AGENT][NEUTRAL] Call reference is gonna be my name with my last initial and then today's date. My name is [PII]'s [PII].
[CUSTOMER][NEUTRAL] OK, thank you and also I still have just uh one more claims for different patient.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] May I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, the patient's ID is 02475815.
[AGENT][NEUTRAL] Insured's name and date of birth?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh yes, the patient's uh first name is [PII]. Last name is [PII] is on sale, and the date of birth is [PII].
[AGENT][POSITIVE] Thank you, data service?
[CUSTOMER][NEUTRAL] Uh, 124. 25 and the total charge is $10,918.78.
[AGENT][NEUTRAL] Do you have any sort of different amount after the primary paid?
[CUSTOMER][NEUTRAL] Uh, after the primary pay, the amount which transferred to the secondary is $1,473.35.
[AGENT][NEUTRAL] Not showing that we have any claims on file for that amount.
[CUSTOMER][NEUTRAL] Can I have the membership I date?
[AGENT][NEUTRAL] Uh yes. Policy effective date on this is [PII]. Patient is still active.
[CUSTOMER][NEUTRAL] And the time limit.
[AGENT][NEGATIVE] No timely filing.
[CUSTOMER][NEUTRAL] Fanning and the.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, so, uh.
[CUSTOMER][NEUTRAL] There would be no reference number, right?
[AGENT][NEUTRAL] I mean, you can use my name in today's date for the no claim on file if you would like.
[CUSTOMER][POSITIVE] OK. OK, thank you so much, sir, for your information and having me on. That's all I need for today and have a very blessed day.
[AGENT][NEUTRAL] You too. Bye-bye.