AccountId: 011433970860
ContactId: 2d0f1e83-b6ff-490f-9b8b-758ab454d023
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 560960 ms
Total Talk Time (AGENT): 149417 ms
Total Talk Time (CUSTOMER): 198467 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/2d0f1e83-b6ff-490f-9b8b-758ab454d023_20250321T17:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Flo's office. How are you doing today?
[AGENT][POSITIVE] I'm doing good, [PII]. How are you doing today?
[CUSTOMER][NEUTRAL] I'm fine and so, uh, if you don't mind, could you provide me a claim status for a patient, please.
[AGENT][NEUTRAL] Yes, I can help you with claim status, sir. Can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] So it's going to be [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Shortly the policy ID would be 01960211 M as in Mike L as in Lima 8.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Patient date patient name, first name is [PII] and last name is spelled as [PII].
[AGENT][NEUTRAL] OK. And then what's [PII]'s date of birth, please?
[CUSTOMER][NEUTRAL] Uh, date of birth would be [PII].
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[CUSTOMER][NEUTRAL] To, and Toy, like, uh, I can see that your voice is breaking, so.
[AGENT][NEUTRAL] OK, let me see if I can adjust that, sir.
[CUSTOMER][POSITIVE] Thank you. Thank you, [PII].
[AGENT][NEUTRAL] OK, thank you, [PII], can I please get the data service and the charge amount?
[CUSTOMER][NEUTRAL] So it's 120 out of $25 and the total charge amount would be $486 even.
[AGENT][NEUTRAL] OK. And that is 130 of 25. Is that correct?
[CUSTOMER][NEUTRAL] No, it's 128 of 25.
[AGENT][NEUTRAL] 28, 28.
[CUSTOMER][POSITIVE] Yeah, I got it.
[AGENT][NEUTRAL] OK. And then what is.
[AGENT][NEUTRAL] Thank you sir and then what is the amount, the charge amount after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] So the remaining charge amount would be $258.32.
[AGENT][NEUTRAL] OK and then can you give me the name of the facility that you're calling from?
[CUSTOMER][NEUTRAL] Sure, I'm calling from Acumen.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm gonna put you on a brief hold while I look up this claim for you, [PII] and I'll be right back.
[CUSTOMER][POSITIVE] Sure, take your time, please.
[AGENT][POSITIVE] Thank you, sir.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you, [PII], for holding for me. So, looking at data service of [PII] for [PII] I'm gonna say this name wrong, [PII].
[AGENT][NEUTRAL] I do not find a claim on file for that date of service.
[CUSTOMER][NEUTRAL] Uh, may I know the payer ID of this, uh, American public life?
[AGENT][NEUTRAL] Yes, sir. It is 60801.
[CUSTOMER][NEUTRAL] 6 is it.
[CUSTOMER][NEUTRAL] Uh, but as per my system I can see that this claim was sent via paper claim.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] OK, I do not show that we have received it um looking on that data service I don't have anything for the month of January at all that's on file for a claim.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh, so if you don't mind, could you check whether do you have any front end projection by any chance?
[AGENT][NEUTRAL] I'm sorry, can you repeat the question, sir?
[CUSTOMER][NEUTRAL] Uh, uh, if you, you can check whether the claim was that with your ad, sorry, with your adjudicator system.
[AGENT][NEGATIVE] No, it's not, it's not in, we haven't received it.
[CUSTOMER][NEUTRAL] What are you saying that there is no claim on file, right?
[AGENT][NEUTRAL] Correct. Not for that date of service.
[CUSTOMER][NEUTRAL] Uh, uh, give me a moment and let, let me check whether I do have any other information about this claim. If you don't mind, can I put a call on a hold, hold a minute or a minute or two?
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] Yes, that's fine. Go ahead. Take your time, sir.
[CUSTOMER][POSITIVE] Thank you, [PII].
[CUSTOMER][NEUTRAL] Uh, hello. Thank you, thank you for being on hold, and, if you don't mind, could you provide me a timely limit for a claim to be to submit again?
[AGENT][NEGATIVE] Uh, we don't have a timely filing limit.
[CUSTOMER][NEUTRAL] So no time limit, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and if you don't mind, may I know the patient is active for the data service, please?
[AGENT][POSITIVE] Yes, let me give you the effective date.
[AGENT][NEUTRAL] The effective date of the policy is [PII] and the policy is still active.
[CUSTOMER][NEUTRAL] Still active, OK, and you act as secondary of the, uh, you act as secondary for the patient, right?
[AGENT][NEUTRAL] Yes, we are secondary.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] So sorry about that.
[CUSTOMER][NEUTRAL] OK [PII], thank you for that. And if you don't mind, uh, [PII], could you provide me the call reference number for this claim, please?
[AGENT][NEUTRAL] Yes, sir, you can use my name and today's date.
[CUSTOMER][NEUTRAL] So it's [PII], today's day, right?
[AGENT][NEUTRAL] It's uh instead of I it's [PII]
[CUSTOMER][POSITIVE] [PII], thank you for that.
[CUSTOMER][POSITIVE] OK, thanks for assisting me and have a great day.
[AGENT][POSITIVE] You too, [PII]. You have a great weekend. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, so, so sorry, I do have a doubt as per in my system I can see that, uh, this particular claim was denied for duplicate claim. If you don't mind, I do have any, uh, I do have a claim number. Can you check with that please?
[AGENT][POSITIVE] Yes, absolutely.
[CUSTOMER][NEUTRAL] Uh, so, thank you. uh, do, uh, so the claim number would be 250.
[CUSTOMER][NEUTRAL] 451-401-6
[AGENT][NEUTRAL] OK, that is not our claim number.
[CUSTOMER][NEUTRAL] So it's not your claim number, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] So thank you. OK, got it. Thank you for that.
[CUSTOMER][POSITIVE] Oh, by the way, [PII], thanks for assisting me and have a safe day.
[AGENT][POSITIVE] OK, you, you too, [PII], have a wonderful weekend and thank you for calling APL.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Bye bye, sir.
[CUSTOMER][POSITIVE] Thank you, bye bye.