AccountId: 011433970860
ContactId: 0c58ccba-ebe4-4d4a-a63a-48bf9166c1e3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 682739 ms
Total Talk Time (AGENT): 201714 ms
Total Talk Time (CUSTOMER): 213971 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/0c58ccba-ebe4-4d4a-a63a-48bf9166c1e3_20250424T16:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII] and last initial is [PII], calling on a claim, please.
[AGENT][NEUTRAL] Hey [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Uh huh, [PII] and that is direct.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and what is the policy number of the patient?
[CUSTOMER][NEUTRAL] It's 01954708, M as in Mary, L as in Larry, the number 8.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Is this a, is this like a gap policy?
[AGENT][NEUTRAL] It is, it's a secondary, yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, what's the data service on that?
[CUSTOMER][NEUTRAL] Data service is July 9 of 24, in just a moment here, total charges is $17,600.
[AGENT][NEUTRAL] OK, let's see. Um, this policy number you gave me termed 111-2023. Let me see if there's a
[AGENT][NEUTRAL] Uh, more recent policy.
[CUSTOMER][NEUTRAL] Did you say turned 11 1 of 24?
[AGENT][NEUTRAL] Uh, no, it turned 11 1 of 23.
[AGENT][NEUTRAL] But I, they, they have a more recent policy number, so let me get that pulled up.
[CUSTOMER][POSITIVE] Oh, I'm sorry.
[CUSTOMER][NEUTRAL] OK, that might explain a lot.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm sorry. Will you give me that data service again? 79?
[CUSTOMER][NEUTRAL] Uh-huh. 79 of 24.
[AGENT][NEUTRAL] And what were the bill charges?
[CUSTOMER][NEUTRAL] Um, the total charge is $17,600.
[AGENT][NEUTRAL] OK, let me see what we got going.
[AGENT][NEUTRAL] OK, looks like we received 3-12-2025. We process that on 3-17-2025.
[AGENT][NEUTRAL] And let's see what we've got.
[AGENT][NEUTRAL] OK, it looks like service is not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, so.
[CUSTOMER][NEUTRAL] How about if we go through the rest of these because I'm betting first of all I probably should get a good policy number since this one isn't any good.
[CUSTOMER][NEUTRAL] Before I forget that part.
[AGENT][NEUTRAL] Uh, yeah.
[AGENT][NEUTRAL] Sure, yeah, that policy numbers, so she's she's got two other policy numbers. This one actually termed
[AGENT][NEUTRAL] Uh, 1125. So do you want, because she's got another policy number, effective [PII]. Do you want that policy number or do you want this policy number?
[CUSTOMER][NEUTRAL] So 11 of 24, probably the one, OK, since the one turned 111 of 23, that new one probably started what, 112 of 23 to 11 of 25.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] This one was from 11123 to 11 of 25, and then she's got a new policy starting 1125.
[CUSTOMER][NEUTRAL] Alright, how about we do let's do both of them, so how about the 11 1 of 23 to 1 or 12:31.
[AGENT][NEUTRAL] Um, that one is
[CUSTOMER][NEUTRAL] Of 24 actually.
[AGENT][NEUTRAL] That one's 243.
[AGENT][NEUTRAL] 0719.
[CUSTOMER][NEUTRAL] And then
[AGENT][NEUTRAL] In the current policy.
[AGENT][NEUTRAL] Uh, that number is 259.
[AGENT][NEUTRAL] 5146.
[CUSTOMER][POSITIVE] OK, that way we can get, you know, we know what we're doing here.
[CUSTOMER][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Alright, we're gonna start from.
[CUSTOMER][NEUTRAL] [PII], well that's it says patient, never mind. So how about 116 of 24 $16,600.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK, 116.
[AGENT][NEUTRAL] OK, 357.
[AGENT][NEUTRAL] OK, that one was received 227-25 process 3325.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] You can just say if it's the same denial reason.
[AGENT][NEUTRAL] Um, that's what I'm looking up. Let's see, um.
[AGENT][NEUTRAL] Looks like it's a duplicate. Let me see what the original is.
[AGENT][POSITIVE] Oh goodness, let's see.
[AGENT][NEUTRAL] Says it's a duplicate, but I don't see the original. Let's see.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Said 116 2024, correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, there it is. 3 224.
[AGENT][NEGATIVE] OK, that one was received 116-2025 process 117-2025, and denial is.
[AGENT][NEUTRAL] Uh, same thing, service not covered when performed in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So even though it's dated 116, it was received 1/16?
[AGENT][NEUTRAL] Uh, we received
[CUSTOMER][NEUTRAL] 0 25. Never mind. I'm sorry.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Almost a year to the day. It is a year to the day. That's just weird. OK. Um, how about 319 of 24?
[AGENT][NEUTRAL] Let's see uh.
[CUSTOMER][NEUTRAL] Nobody's checked on any of these so I may as well do it.
[AGENT][NEUTRAL] OK, it looks like.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, that one was received 116-2025. Process 117-2025.
[AGENT][NEUTRAL] And
[AGENT][NEGATIVE] Same denial, not covered when performed in doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK. And 5:14 of 24, um.
[CUSTOMER][NEUTRAL] 17,600, same thing.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Uh, receive 116, process 117 2025 and
[AGENT][NEUTRAL] Same thing.
[CUSTOMER][NEUTRAL] All right. And [PII] of [PII]?
[AGENT][NEUTRAL] OK, so [PII], I don't have a claim for that date actually.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How about 1029, 24?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Uh, don't have a claim for that date either.
[CUSTOMER][NEUTRAL] OK, they may have just decided since it doesn't cover.
[CUSTOMER][NEUTRAL] How about 1224 24.
[AGENT][NEUTRAL] Uh, that one received 131, 2025, process 23, 2025 and
[AGENT][NEGATIVE] Same thing, same denial.
[CUSTOMER][NEUTRAL] OK, and one final 1 [PII].
[AGENT][NEUTRAL] OK, let's see, you know, on the new policy. Let me get that one pulled up.
[AGENT][NEUTRAL] 2595.
[CUSTOMER][NEUTRAL] That one you may not have.
[CUSTOMER][NEUTRAL] But she still has that same policy, right?
[AGENT][NEUTRAL] She does.
[AGENT][NEUTRAL] Um, yes, don't show any claims on file. Do you wanna file under that new policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yep, all right.
[CUSTOMER][POSITIVE] I gotta figure out what she's got going on here because I've got some other stuff listed and it's like oh this is interesting right um.
[CUSTOMER][NEUTRAL] I just need [PII] a call reference number.
[AGENT][NEUTRAL] Uh, just my name, [PII], first initial to last name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK. All right, perfect. Thanks a lot, [PII]. You have a great day and weekend ahead.
[AGENT][POSITIVE] All right, thank you for calling APL and I hope you do too.
[CUSTOMER][NEUTRAL] Mhm bye bye.
[AGENT][NEUTRAL] Bye