AccountId: 011433970860
ContactId: 12bfa1a0-c48e-4a66-9907-bea174639d1e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 310920 ms
Total Talk Time (AGENT): 90769 ms
Total Talk Time (CUSTOMER): 119303 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/12bfa1a0-c48e-4a66-9907-bea174639d1e_20250306T18:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. This is [PII] from the provider office and I'm sorry, is, is it your name spelled like [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, thank you, uh, [PII] member and I want to verify the claim status for them.
[AGENT][NEUTRAL] OK, I'm happy to check claim status. What is the patient's policy number?
[CUSTOMER][NEUTRAL] It is 021-91897.
[AGENT][NEUTRAL] And if I can get the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] That is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] All right, thank you so much. And then what's the date of service?
[CUSTOMER][NEUTRAL] It is um [PII] and the bill amount is $681 even.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][POSITIVE] Sure, thank you.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It
[AGENT][POSITIVE] All right. Thank you so much for your patience and waiting on that. So it looks like we did receive this claim. Uh, looks like the claim received date, let me get that for you, was.
[CUSTOMER][NEUTRAL] Uh, I just only want to know the denial reason of [PII]. Thank you.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Laboratory tests are not covered.
[CUSTOMER][NEUTRAL] I'm sorry, can you repeat that?
[AGENT][NEUTRAL] Laboratory tests are not covered under the patient policy.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] That laboratory test tests are not covered?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Under patient plan.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Um, so is this all the patient responsibility?
[AGENT][NEUTRAL] We're not able to advise on patient responsibility that would be up to the facility or provider to bill the patient.
[CUSTOMER][NEUTRAL] OK, sure. Uh, OK. Can you provide me the effective date of this number then?
[AGENT][NEUTRAL] Effective date is [PII]. Patient is still active.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, uh, can you also provide me the plan type of the member?
[AGENT][NEUTRAL] Uh, the member has a limited benefit hospital indemnity plan.
[CUSTOMER][NEUTRAL] OK, can you provide me the call reference number?
[AGENT][NEUTRAL] Call references my name with my last initial than today's date. The last initial to my name is [PII].
[CUSTOMER][NEUTRAL] OK. Uh sir, actually, I have one more patient. Can you also verify that?
[AGENT][NEUTRAL] Mhm. Absolutely. What's the policy number?
[CUSTOMER][NEUTRAL] Thank you. Uh, the policy number for that, oh, wait a second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yep.
[CUSTOMER][NEUTRAL] The policy number for this one patient is 01477436.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Uh, [PII] and $681 is the amount.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] All right, this claim was received for [PII], the claim was denied. We need the explanation of benefits from the primary insurance.
[CUSTOMER][NEUTRAL] For the son.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me a second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, can you uh provide me the effective date for this number?
[AGENT][NEUTRAL] Uh, the effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] To present?
[AGENT][POSITIVE] Mhm, correct, still active.
[CUSTOMER][NEUTRAL] The core reference is same right.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you. Have a nice day, [PII]. Have a wonderful day and happy weekend. Bye-bye.
[AGENT][NEUTRAL] You too [PII] bye bye.