AccountId: 011433970860
ContactId: 0b387709-03c2-4bb6-815e-3386220d2cd4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 309600 ms
Total Talk Time (AGENT): 126769 ms
Total Talk Time (CUSTOMER): 72633 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/0b387709-03c2-4bb6-815e-3386220d2cd4_20250124T19:04_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, hi, good afternoon, [PII]. My name is [PII]. I'm calling from Saint Peter's Health Partners. I have a question about a claim that denied, please.
[AGENT][POSITIVE] What would be my pleasure to assist you with that claim information, [PII]. What is a good call back number?
[CUSTOMER][NEUTRAL] Direct line is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Um, it's 02347343.
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth [PII].
[AGENT][NEUTRAL] Thank you and do you have that claim number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The most recent claim number I have is for a duplicate.
[CUSTOMER][NEUTRAL] And that claim number is 3547024.
[AGENT][NEUTRAL] OK, thank you. Let me get that original claim. Can you verify the date of service build amount and provider name?
[CUSTOMER][NEUTRAL] 3 21244.
[CUSTOMER][NEUTRAL] Uh, actually I have two claims for her, so.
[CUSTOMER][NEUTRAL] Um, they're both on the same day. First one, I gave you, um, is for $26.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that provider is going to be [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I do see the original claim. Let me get that pulled up for you.
[AGENT][NEUTRAL] And at St. Peter's Health Partners.
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] So it looks like on this $26 charge.
[AGENT][NEUTRAL] We received the original claim on.
[AGENT][NEUTRAL] [PII] and no, that's it hang on.
[AGENT][NEUTRAL] 354
[AGENT][NEUTRAL] I apologize. Let me get that original claim number. I apologize.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] 0
[AGENT][NEUTRAL] 2369. That claim we received on [PII].
[AGENT][NEUTRAL] And processed on [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And it is not a covered diagnostic test. The covered diagnostic test under this plan is for an MRI, colonoscopy, or a CT scan, and I can provide the original claim number for you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] [PII], that original claim number is 350.
[AGENT][NEUTRAL] 336 9.
[CUSTOMER][NEUTRAL] OK. And um is the full $26 patient responsibility?
[AGENT][NEUTRAL] So we're not major medical. We don't determine patient responsibility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the other is the same data service.
[CUSTOMER][NEUTRAL] And it is 4.
[CUSTOMER][NEUTRAL] $102.
[AGENT][NEUTRAL] OK, let me get that original claim.
[AGENT][NEUTRAL] 102.
[AGENT][NEUTRAL] 5
[AGENT][NEUTRAL] OK, that claim we received on [PII].
[AGENT][NEUTRAL] And processed on [PII].
[AGENT][NEGATIVE] And this claim was denied.
[AGENT][NEUTRAL] For the same reason.
[AGENT][NEUTRAL] Not a, not, not a covered diagnostic test. Would you like that claim number?
[CUSTOMER][POSITIVE] Alrighty.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] That claim number is 345.
[AGENT][NEUTRAL] 32
[AGENT][NEUTRAL] 18
[CUSTOMER][NEUTRAL] OK. And do you do call reference numbers at all?
[AGENT][NEUTRAL] It's gonna be my name and today's date. I spell my name [PII].
[AGENT][POSITIVE] And it has been a pleasure to assist you with that claim status, [PII]. Anything else I can help you with?
[CUSTOMER][POSITIVE] Um, that's it. Thank you so much.
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Bye-bye.