AccountId: 011433970860
ContactId: 11014767-cd0e-4c11-adb6-16e45c64b6a3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 309390 ms
Total Talk Time (AGENT): 95666 ms
Total Talk Time (CUSTOMER): 139786 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/11014767-cd0e-4c11-adb6-16e45c64b6a3_20250128T22:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi [PII]. I had a question in reference to a claim. I'm not sure if I hit the right button or not.
[AGENT][NEUTRAL] OK, I can definitely look at a claim for you. Do you have a policy number?
[CUSTOMER][NEUTRAL] Yeah, I do. It is.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] It is policy number 022.
[CUSTOMER][NEUTRAL] 06013 M as in L as in Larry and the number 8.
[AGENT][POSITIVE] All right, thank you for that.
[CUSTOMER][NEUTRAL] Mm mhm.
[AGENT][NEUTRAL] And are you a provider or you the insured?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Provider.
[AGENT][NEUTRAL] All right. And then let me get the patient name and date of birth, please.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Sure. It's [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Alright, thank you for that. What's the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and the build amount.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The billed amount was sorry I have to go on a different screen for that and.
[AGENT][POSITIVE] No worries.
[CUSTOMER][NEGATIVE] Take this pay. Where's the point?
[CUSTOMER][NEUTRAL] OK. The bill amount was $72,559.82 claim total.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Do you have an amount after the primary by chance?
[CUSTOMER][NEUTRAL] Oh, the EOB was weird. Hold on, let me see what I do have the EOB from you guys, so it's probably easier for me. Yeah, it's probably easier to bring that.
[AGENT][NEUTRAL] Oh, do you? OK. If you, if you, yeah, I mean, if you have a claim number specifically you need me to check on, I can do that if you want to give that to me also.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, let me just look the.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK here we go.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK. Claim number 3545593.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] See here
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, yeah, that was the duplicate it looks like it looks like the original claim number was 3531956.
[AGENT][NEUTRAL] And that claim.
[AGENT][NEGATIVE] Looks like it's showing denied. It says service is not covered in doctor's office.
[CUSTOMER][NEUTRAL] OK, and that's what I thought. I just wanted to make sure cause the patient kept saying that it covered his deductible no matter what, and I'm like, well, it's usually if it's hospital-based, and he's like, no, no, it covers it no matter what. I'm like, OK, I'm gonna call and ask just to say I did my due diligence.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Yeah, no, it was resubmitted a second time, that one that you gave me and denied again just saying, but it was denied for being a duplicate, um, you know, so yeah, it looks like the first claim held as far as, you know, not being covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, only covers. OK, perfect. And can I just get your name and a reference number just so I, in case he asks.
[AGENT][NEUTRAL] Yeah, absolutely. Call reference is actually my name with my last initial than today's date. My name is [PII], which is [PII] Last initial is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, perfect. Thank you, [PII]. I appreciate it.
[AGENT][POSITIVE] You're welcome. Have a good one.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thank you. Bye.