AccountId: 011433970860
ContactId: 04ebc600-c161-4c7e-92b8-e8f304ee68dd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 217619 ms
Total Talk Time (AGENT): 112947 ms
Total Talk Time (CUSTOMER): 72250 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/04ebc600-c161-4c7e-92b8-e8f304ee68dd_20250108T21:16_UTC.wav
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[AGENT][NEUTRAL] Contacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] and I'm calling from provide office.
[AGENT][NEUTRAL] [PII], how can I help you?
[CUSTOMER][NEUTRAL] Uh, yeah, I actually I'm looking for the claim denial reason. Can you confirm that?
[AGENT][NEUTRAL] Uh, I can certainly look at a claim. What is that policy number, please?
[CUSTOMER][NEUTRAL] Of course it's uh 02487395.
[AGENT][NEUTRAL] Thank you, and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, of course it's, let me see. OK, it's [PII]. Date of birth is [PII].
[AGENT][POSITIVE] I appreciate that. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. um, and what date of service are we looking for for this individual?
[CUSTOMER][NEUTRAL] I'm looking, yeah, of course it's for [PII] built on [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] The claim number for this.
[AGENT][NEUTRAL] Is 3503.
[AGENT][NEUTRAL] 058.
[AGENT][NEUTRAL] Uh, that's the claim number. It looks like we received the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On uh
[AGENT][NEUTRAL] The [PII], we processed it on the [PII]. Now, there was a single paper check. The check number is 2001.
[AGENT][NEUTRAL] 3, excuse me, 1366 and that's uh
[AGENT][NEUTRAL] was for $50.
[AGENT][NEUTRAL] Yeah, it looks like um.
[AGENT][NEUTRAL] The check was cashed on the [PII]. It went
[AGENT][NEUTRAL] To a [PII].
[CUSTOMER][NEUTRAL] OK. And uh what about the rest amount?
[AGENT][NEUTRAL] Uh, it was $50 and that's the, the most that the policy pays out.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK. Yeah. Uh, is there any patient responsibilities?
[AGENT][NEUTRAL] Well, our obligation was paid with that $50 so anything above and beyond that would be the patient's responsibility.
[CUSTOMER][NEUTRAL] Do you have any allowed amount for this claim?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] As for my checking, I'm seeing the claim as it, is there any denial on this claim?
[AGENT][NEUTRAL] This is
[AGENT][NEUTRAL] Uh no, there's no denial on it. Um, this is a limited benefit policy. It pays a flat rate benefit for certain services, and in this case, the, the, um, maximum benefit was at $50. So, um, because this is not major medical, uh there's not a, a, a, um, yeah.
[CUSTOMER][NEUTRAL] Oh, OK, is OK, is there any discount on this claim, any contractual amount?
[AGENT][NEUTRAL] No, there is not.
[AGENT][NEUTRAL] Uh, no, there's, there's no discount on it.
[CUSTOMER][NEUTRAL] OK, uh, apart, OK. OK. Apart from $50 the rest will be the patient responsibility.
[AGENT][NEUTRAL] Well, it's the only thing I can tell you is that, is that this is the most that we're paying, so they yeah, they may have another insurance.
[CUSTOMER][NEUTRAL] OK, no issues. Sure, sure, sure. OK, OK. May I have the reference number for this call, [PII]?
[AGENT][NEUTRAL] My name is [PII]. The first letter of my last name is [PII], and we'll use that today's date as our reference.
[CUSTOMER][POSITIVE] Have a 3D CD and good one.
[AGENT][POSITIVE] OK, thanks for contacting AP have a good.