AccountId: 011433970860
ContactId: 1676ff1d-1276-4ba9-ad74-6c265e6641f9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 346260 ms
Total Talk Time (AGENT): 85294 ms
Total Talk Time (CUSTOMER): 86221 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/1676ff1d-1276-4ba9-ad74-6c265e6641f9_20250422T16:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] here. I'm calling from provider's office to check on the denial status.
[AGENT][POSITIVE] OK, [PII], I'm happy to check on a claim for you. Can I get the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number will be 02564245.
[AGENT][NEUTRAL] And do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, uh, the callback number will be [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth?
[CUSTOMER][POSITIVE] Thank.
[CUSTOMER][NEUTRAL] Yes, official name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] Alright thank you and what's the date of service?
[CUSTOMER][NEUTRAL] The service will be [PII].
[AGENT][NEUTRAL] And the build out.
[CUSTOMER][NEUTRAL] But the amount will be $83,407.96.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Alright, so I do show that we received a claim for the state of service. The claim was received on [PII].
[AGENT][NEUTRAL] Claim was denied [PII]. The insured's primary provided full benefits, so we're showing there was nothing for us to pay.
[CUSTOMER][NEUTRAL] OK. So, uh,
[CUSTOMER][NEUTRAL] Who is the uh primary?
[AGENT][NEGATIVE] Unfortunately, we don't have that information. You would have to contact the insured.
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Uh, so [PII], is, is this, uh, primary paid max claim, right?
[AGENT][NEUTRAL] Uh, we show the primary paid full benefits. There was nothing for us to pay since we're the secondary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So, is there a patient?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just a moment. I'm just checking some information.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Thank you so much uh for your patience, [PII]. Uh, so, uh, have you, uh, considered the primary payment, therefore, there is no payment?
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] Correct. The denial reads that the primary insurance paid in full, so there was nothing for us to pay.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And how much is the allowed amount for the secondary that is you, uh.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] The outpatient benefit max on this patient's plan is per calendar day, which is 1500.
[CUSTOMER][NEUTRAL] 1500, OK.
[CUSTOMER][NEUTRAL] OK, that's all I have for today. May I get the call reference number?
[AGENT][NEUTRAL] Call references my name with my last initial than today's date. My name is [PII], that is spelled [PII]
[AGENT][NEUTRAL] Initial to my last name is [PII].
[CUSTOMER][NEUTRAL] [PII]. OK.
[CUSTOMER][POSITIVE] Thank you so much, sir, for assisting me today. I hope you have a great day ahead.
[AGENT][NEUTRAL] You too, [PII]. Bye-bye.