AccountId: 011433970860
ContactId: 0e1dbb62-4f16-4fc2-99a3-0360dae7e6c7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 320059 ms
Total Talk Time (AGENT): 112005 ms
Total Talk Time (CUSTOMER): 75249 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/0e1dbb62-4f16-4fc2-99a3-0360dae7e6c7_20250422T14:33_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. I'm calling from Radiy Incorporated to check claim status for a patient.
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status and [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, that would be [PII].
[AGENT][NEUTRAL] Thank you and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, it is D437.
[CUSTOMER][NEUTRAL] 30694.
[AGENT][NEUTRAL] Do you see a policy certificate number? Um, it's gonna start with the 0 followed by 7 digits. That's gonna be our number, that the numbers for IMA only.
[CUSTOMER][NEUTRAL] Uh, let me see real quick if I can get it pulled up.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, is there any way we can search for the patient by their name?
[AGENT][NEUTRAL] OK, um, yes, bear with me just a second.
[AGENT][NEUTRAL] May I have the spelling of the last name?
[CUSTOMER][NEUTRAL] Yes, it's [PII]
[AGENT][NEUTRAL] That's [PII], the last two letters.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, and may I have the spelling of the first name?
[CUSTOMER][NEUTRAL] Yes, it's [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Do you have an address for Mr. [PII]?
[CUSTOMER][NEUTRAL] I do. It is [PII].
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] What is his date of birth?
[CUSTOMER][NEUTRAL] Uh, that would be [PII].
[AGENT][POSITIVE] Alright, thank you.
[AGENT][NEUTRAL] OK, I found him. And what is the date of service?
[CUSTOMER][NEUTRAL] Uh, that would be [PII], [PII].
[AGENT][NEUTRAL] OK, how much is the total charge of the claim?
[CUSTOMER][NEUTRAL] $329.07.
[AGENT][NEUTRAL] OK. Thank you. Now it's [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, let me pull this EOB and for future, you can check claim status online through our website at [PII], and that's just optional. You can always call and it's gonna be one minute. I'm waiting on the EOB to pull up.
[CUSTOMER][POSITIVE] No worries.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, so it looks like we processed the claim on [PII] and the claim was denied. The reason for this denial is that benefit maximum for the date of service has been met.
[CUSTOMER][NEUTRAL] OK and then is that patient responsibility then or no?
[AGENT][NEUTRAL] Um, if you can go back to what the major medical decided to do with that plane.
[AGENT][NEUTRAL] So it's up to the provider's discretion, basically.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, if I could get your name and your call reference number please?
[AGENT][NEUTRAL] My name is [PII], that's [PII].
[AGENT][NEUTRAL] And we don't have reference numbers. You can use my name in today's date.
[CUSTOMER][POSITIVE] OK, thank you so much for your help, so.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day, Miss [PII].
[CUSTOMER][NEUTRAL] You too goodbye.
[AGENT][POSITIVE] Thank you