AccountId: 011433970860
ContactId: 0d77f6ff-3c08-4917-9f79-3321e3e86cf7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 339079 ms
Total Talk Time (AGENT): 85179 ms
Total Talk Time (CUSTOMER): 114207 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/0d77f6ff-3c08-4917-9f79-3321e3e86cf7_20250530T20:09_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is [PII], and I'm calling on behalf of the provider's office looking for the status of the follow up the denial claims.
[AGENT][POSITIVE] Good
[AGENT][NEUTRAL] OK, I can verify claim status for you. And [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] I'm sure it's D delta and 468-02083.
[AGENT][NEUTRAL] It's not one of our policy numbers. Do you have the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Sure. The patient's first name is [PII].
[AGENT][NEUTRAL] Spell that, please.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Sure. It's [PII], [PII], and the last name is [PII]'s [PII].
[AGENT][NEUTRAL] OK. And the date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, and what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] Data service [PII] and amount charges are $3500.76.
[AGENT][NEGATIVE] Uh, repeat that charge amount again and your phone cut out.
[CUSTOMER][NEUTRAL] Uh sure it's 3000.
[CUSTOMER][NEUTRAL] $527.76.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what was the name of the provider's office?
[CUSTOMER][NEUTRAL] Sure, give me a moment. The provider office, uh, facility name is Cadac Regional Medical Center.
[AGENT][NEUTRAL] OK, I'm showing $100 was paid on this claim.
[AGENT][NEUTRAL] And with that payment at max there benefit for the data service.
[CUSTOMER][NEUTRAL] I'm sorry, can you please repeat that for me?
[AGENT][NEUTRAL] Uh, the claim was denied. It paid $100 and with that payment, it matched their benefit for the data service.
[CUSTOMER][NEUTRAL] The maximum benefit met on the date of service?
[AGENT][NEUTRAL] The claim paid $100.
[AGENT][NEUTRAL] And with that payment of $100 it mas their benefit for the date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right then.
[CUSTOMER][NEUTRAL] So can you please provide me the information? Is there any denial over this claim?
[AGENT][NEUTRAL] Sir, I just explained the claim paid $100 so it wasn't denied.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Let me check it up. Please bear with me.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, but as per checking up on my system, uh, we expected the more payment on this claim.
[AGENT][NEUTRAL] Well, under the patient's policy, the max payable is just $100.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK. So, uh, the amount is the patient responsibility?
[AGENT][NEUTRAL] We can't give patient responsibility. We can only verify how the claim was processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, all right. So can you please provide me your first name, last name, initial, and the caller reference number.
[AGENT][NEUTRAL] It's [PII], last initial [PII]
[AGENT][NEUTRAL] And you may use my name at today's date as reference.
[CUSTOMER][POSITIVE] OK. All right, thank you so much, [PII] for providing the information. Have a nice day. Bye.
[AGENT][POSITIVE] Mhm thank you for calling APL bye.