AccountId: 011433970860
ContactId: 1996a209-13a8-4bca-9c4b-312055ee79b1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 701700 ms
Total Talk Time (AGENT): 276996 ms
Total Talk Time (CUSTOMER): 402239 ms
Interruptions: 22
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/1996a209-13a8-4bca-9c4b-312055ee79b1_20250414T15:00_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Coning APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, ma'am. My name is [PII]. Initial of my last name is there. I am calling to you from provider office Clear Lake specialities. I need general claim status.
[AGENT][NEUTRAL] OK great, I can certainly have the claim status. What is that policy number, please?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] My callback number is [PII] and the [PII] is [PII].
[AGENT][NEUTRAL] Thank you. Um, what is the policy number, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] The policy number is 02556561.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The patient's last name is [PII] and first name is [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you very much. And is there a particular date of service that we're looking for for [PII]?
[CUSTOMER][NEUTRAL] And is there a particular date.
[CUSTOMER][NEUTRAL] Oh, OK. The date of service is [PII], and total charges amount is $507 even.
[AGENT][POSITIVE] OK, thank you very much. Let's see.
[CUSTOMER][POSITIVE] OK, thank you
[AGENT][NEUTRAL] So the claim number for this.
[CUSTOMER][NEUTRAL] So it's the work today.
[AGENT][NEUTRAL] It's 357.
[CUSTOMER][NEUTRAL] It's 357.
[AGENT][NEUTRAL] 63.
[AGENT][NEUTRAL] Excuse me, I'm sorry, 357.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Zip code [PII].
[AGENT][NEUTRAL] Um, 36, sorry, 36.
[CUSTOMER][NEUTRAL] I'm sleeping
[AGENT][NEUTRAL] 58. So that's 3573658. Now, we received that claim.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 35357.
[CUSTOMER][NEUTRAL] Next
[AGENT][NEUTRAL] At 365 8.
[CUSTOMER][NEUTRAL] 365 3658. OK, and received it.
[AGENT][NEUTRAL] Thank you. Yes, and we received that claim on [PII], and we processed it on the [PII]. Now, the maximum benefit for this type of service is $100. So what we did was we submit, uh, we sent a check out uh at that time.
[CUSTOMER][NEUTRAL] Thank you receive that on uh [PII] and we process it on the [PII] of that some benefits is $100. So what we did is we sent out at that time for $100. It was a.
[AGENT][NEUTRAL] For $100 it was a single paper check.
[AGENT][NEUTRAL] The check number is 203.
[CUSTOMER][NEUTRAL] The check number is 2019.
[AGENT][NEUTRAL] 1926.
[AGENT][NEUTRAL] And I'm just checking
[CUSTOMER][NEUTRAL] The claim is paid at $100 is that right?
[AGENT][NEUTRAL] That's correct, yes. And, and the uh check number, let's see, as I mentioned before, it's 2031926. Now, it looks like that was cash. This was sent to 500.
[CUSTOMER][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] 7.
[CUSTOMER][NEUTRAL] Well it looks like that was.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] West
[AGENT][NEUTRAL] Tobyiachi
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] [PII], and that's in [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it looks like the check was was processed or or cashed on.
[CUSTOMER][NEUTRAL] Looks like the check is the process or.
[AGENT][NEUTRAL] [PII], um, but it's just gonna be that $100. It's not gonna be anything more than that.
[CUSTOMER][NEUTRAL] Not so.
[CUSTOMER][NEUTRAL] Um, but it's just gonna be that $100.
[CUSTOMER][NEUTRAL] Oh, OK. The claim number is 3573658. Received it on [PII] and finalized date is [PII], is that right?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK, and the claim, uh, paid amount is $100 is that right?
[AGENT][NEUTRAL] Yes, that's, that's all that that that is the most of this will pay for that sort of service. Now there's any additional fees, that would be between the insured and the provider.
[CUSTOMER][NEUTRAL] Yeah, so the problem would be that there's any additional fee that would be putting.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I have the one more comment please, same number.
[AGENT][NEUTRAL] OK, yes, and what is that, uh, data service?
[CUSTOMER][NEUTRAL] OK, yes, and what is that uh through the.
[CUSTOMER][NEUTRAL] [PII] and total charges amount is $176.
[AGENT][NEUTRAL] $176. OK.
[AGENT][NEUTRAL] The claim number for this one is 357.
[CUSTOMER][NEUTRAL] So this one is 357.
[AGENT][NEUTRAL] 5436.
[CUSTOMER][NEUTRAL] 542
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Now, on this particular one, as I mentioned before that the maximum benefit had already been paid.
[CUSTOMER][NEUTRAL] Well, on this particular one, I mentioned before that the benefit is.
[AGENT][NEGATIVE] So for this one, he was denied.
[CUSTOMER][NEUTRAL] So this one.
[AGENT][NEUTRAL] Uh, because the benefit maximum had been met.
[CUSTOMER][NEUTRAL] Uh, because the maximum.
[AGENT][NEUTRAL] For the the most that it will be paid out for this service for this date.
[CUSTOMER][POSITIVE] Most will be paid out the service for this day.
[AGENT][NEUTRAL] would have been that $100. So this claim was um looks like we received this claim.
[CUSTOMER][NEUTRAL] More than $900 so this is.
[CUSTOMER][NEUTRAL] It.
[AGENT][NEUTRAL] Uh, on the, um, [PII], we process it on the [PII], um,
[CUSTOMER][NEUTRAL] On the [PII] deposited on the [PII].
[AGENT][NEUTRAL] But that, uh, the benefit had already been paid out.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] that the benefit is already paid off.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Ma'am, uh, the denied reason again details with benefits.
[AGENT][NEUTRAL] Uh, the, the total benefits, um, for this service that, that, that, that this policy will pay out is $100.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] For this this this policy will come out 10 done.
[AGENT][NEGATIVE] So the first claim that you gave me was paid that $100 was paid, but the second claim is the same date of service, and so the benefit had already been paid, had already been maxed. So that's why this one was denied.
[CUSTOMER][NEUTRAL] So the first thing is paid at $100 to pay the second claim is the same day so the benefit that has already been paid.
[CUSTOMER][NEUTRAL] That's why.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, the, the denied benefits was max maximum, is that right?
[AGENT][POSITIVE] That's right. The, the maximum benefits have been paid out.
[AGENT][NEUTRAL] And that's why we, we weren't able to pay anything else.
[CUSTOMER][NEUTRAL] That's why
[CUSTOMER][NEUTRAL] Uh, OK, I have the one more claim, same date of service then different total charges amount is $194.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, this looks like this is for durable medical, um,
[CUSTOMER][POSITIVE] Yeah this is this is for durable data.
[AGENT][NEUTRAL] That claim number is 357.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] That claim number is 357.
[AGENT][NEUTRAL] 365 5.
[CUSTOMER][NEUTRAL] 365 5. Mhm.
[AGENT][NEUTRAL] Now, that particular claim um we received on the [PII] and we processed it on the [PII].
[CUSTOMER][NEUTRAL] Now that particular place um they used to be on the [PII] on the [PII].
[AGENT][NEUTRAL] But the policy doesn't cover durable medical.
[CUSTOMER][NEUTRAL] That the cover.
[AGENT][NEUTRAL] So that would, that would have been a denial uh based on the fact that the, the policy just doesn't cover durable medical service.
[CUSTOMER][NEUTRAL] So that was based on the fact.
[CUSTOMER][NEUTRAL] Uh, uh, ma'am, uh, you said the claim is denied due to the medical coverage is not covered for this plan?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, so, no, next I have the corrected claim I please.
[AGENT][NEUTRAL] Uh, there is, um, no timely filing, and you can file this at any time.
[CUSTOMER][NEUTRAL] Oh there is one.
[CUSTOMER][NEUTRAL] Just on the
[AGENT][NEUTRAL] And if you wanted to use.
[CUSTOMER][NEUTRAL] And new claim and no.
[AGENT][NEUTRAL] Oh, pardon?
[CUSTOMER][NEUTRAL] Oh pardon?
[CUSTOMER][NEGATIVE] New family falling.
[AGENT][NEGATIVE] Uh, there's, um, the new claims, there's no timely filing on these policies.
[CUSTOMER][NEGATIVE] There's, um, the new points there's no time on this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] A timely filing for consideration.
[AGENT][NEUTRAL] But yeah, there's no timely filing at all. You can file them at any time.
[CUSTOMER][NEUTRAL] Yeah, there's no time filing at all. You can file.
[CUSTOMER][NEUTRAL] I have uh a mailing address.
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII]?
[CUSTOMER][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Our zip code is [PII].
[CUSTOMER][NEUTRAL] My zip code is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII] excuse me, [PII].
[CUSTOMER][NEUTRAL] 59 [PII].
[CUSTOMER][NEUTRAL] And the fax number?
[AGENT][NEUTRAL] I'm sorry, the what number? The fax number is um 8877.
[CUSTOMER][NEUTRAL] I'm sorry, the what number the fax number.
[CUSTOMER][NEUTRAL] 77
[AGENT][NEUTRAL] 365 [PII].
[CUSTOMER][NEUTRAL] This far.
[CUSTOMER][NEUTRAL] Can you repeat my fax number please?
[AGENT][NEUTRAL] I beg your pardon?
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] The fax number please.
[AGENT][NEUTRAL] It's 877
[CUSTOMER][NEUTRAL] 827.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] Yeah it's, it's 877.
[CUSTOMER][NEUTRAL] OK, 877.
[AGENT][NEUTRAL] 365
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 94
[CUSTOMER][NEUTRAL] Mhm. OK.
[AGENT][NEUTRAL] 23.
[CUSTOMER][NEUTRAL] Your name and please?
[AGENT][NEUTRAL] My name is [PII]. The first letter of my last name is [PII], and we'll use that in today's date as a reference.
[CUSTOMER][NEUTRAL] I mean.
[CUSTOMER][NEUTRAL] Can you spell please?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Is there anything else at all I can help with?
[CUSTOMER][NEUTRAL] Initial of last name
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And go up with one.
[AGENT][NEUTRAL] Uh, it would be that today's date.
[CUSTOMER][NEUTRAL] Uh, it is that.
[CUSTOMER][NEUTRAL] OK, ma'am, uh, confirm, uh, no new claim timely filing and now crossing claim timely filing and now appeal timely filing, is that right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you for your assistance. Have a nice day.
[AGENT][POSITIVE] OK, thanks for contacting AT