AccountId: 011433970860
ContactId: 08689fb2-b597-4689-b34d-3d3271bb6221
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 455649 ms
Total Talk Time (AGENT): 101616 ms
Total Talk Time (CUSTOMER): 122887 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/08689fb2-b597-4689-b34d-3d3271bb6221_20250613T16:53_UTC.wav
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[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] they cut something or whatever so.
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from, uh, Bonseco Laboratory Service. How are you doing today?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][POSITIVE] I'm doing well. I'm sorry I missed your name. Can you please repeat it?
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][POSITIVE] [PII], thank you, Miss [PII], you're doing OK today?
[AGENT][POSITIVE] Yeah I'm good.
[CUSTOMER][POSITIVE] Good, I'm so glad um I'm hoping that you can clarify a denial that we received please.
[AGENT][NEUTRAL] OK, you have, um, could I get a good callback number, [PII], and then I can help you with that claim status.
[CUSTOMER][NEUTRAL] Of course it's [PII].
[AGENT][NEUTRAL] OK, thank you. And what's the policy number for that patient?
[CUSTOMER][NEUTRAL] Uh, let me covering their information, it's 0264909.
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] No, I didn't pull up that policy number. Um, what's the last name of the patient?
[CUSTOMER][NEUTRAL] [PII] first name [PII].
[CUSTOMER][NEUTRAL] Yeah let me see if it if there's something different on the.
[CUSTOMER][NEUTRAL] 026.
[CUSTOMER][NEUTRAL] Oh, you know what?
[CUSTOMER][NEUTRAL] OK, on here it says 02604909.
[AGENT][NEUTRAL] OK, that sounds.
[CUSTOMER][NEUTRAL] Let me fix that on here too.
[AGENT][NEUTRAL] OK, and do you have his date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] And what was the date of service you're calling on?
[CUSTOMER][NEUTRAL] [PII] in the amount of $256.86.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEGATIVE] It looks like it was the place of service, um, wasn't covered under the policy. This is a very limited hospital indemnity plan, um.
[AGENT][NEUTRAL] Finish
[CUSTOMER][NEUTRAL] Right, and the claim was billed for a doctor's office, but the place of service being 11. I know that it doesn't cover independent labs, um, but it was, uh, billed with the, uh, DO, which is the places the doctor's office places service 11.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Which should be covered under the plan.
[AGENT][NEUTRAL] Look what we received.
[AGENT][NEGATIVE] My system just went down. Hold on just a second.
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][POSITIVE] Thank you, I so appreciate your time today.
[AGENT][NEUTRAL] OK. Um, let's see, so.
[AGENT][NEUTRAL] What was that one?
[AGENT][NEUTRAL] OK, I do see doctor's office or place of service, place of service 11.
[CUSTOMER][NEUTRAL] Which is the doctor's office, yeah.
[AGENT][NEGATIVE] No, I don't know why they denied it is that because we'd already paid on that exact same data service for a different provider.
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Yeah, so we had paid for we paid $75 to a different provider for that same data service, so the denial reason is actually incorrect. It should be maximum has been met. Um, I can send that back through for a correct denial, um.
[AGENT][NEUTRAL] That way it's not the incorrect denial, it's not the place of service, it was the.
[AGENT][NEUTRAL] The max has been met for the day. They pay $75 per visit.
[CUSTOMER][NEUTRAL] OK, all right, and that makes sense.
[AGENT][POSITIVE] Sorry about that.
[CUSTOMER][NEUTRAL] No, that's OK. I, um, I can barely get it. It was like, wait a minute. Did I replace the service? Wait, we build right, OK, and that makes sense.
[AGENT][NEUTRAL] Right, yeah, no, that's.
[AGENT][POSITIVE] OK, I'll get that sent back through. You'll give it about 7 working days and then we'll get it corrected EOB sent your way.
[CUSTOMER][NEUTRAL] OK great and do you have a reference number, Ms. [PII]?
[AGENT][NEUTRAL] Uh, yes, it's my name, [PII], first initial to last name, [PII], and today's date. And anything else I can help with today?
[CUSTOMER][POSITIVE] No, not at this time. I really appreciate it and I hope you have a wonderful day and weekend.
[AGENT][POSITIVE] OK, thanks for calling APL. I hope you do too.
[CUSTOMER][POSITIVE] Thank you bye bye.