AccountId: 011433970860
ContactId: 34ba54d8-0d1b-4870-b54c-7c31b1abba61
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 295100 ms
Total Talk Time (AGENT): 150858 ms
Total Talk Time (CUSTOMER): 153058 ms
Interruptions: 6
Overall Sentiment: AGENT=0.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/34ba54d8-0d1b-4870-b54c-7c31b1abba61_20250616T19:00_UTC.wav
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[AGENT][NEUTRAL] For contacting APO, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Prada's office. I'm looking for a claim denial.
[AGENT][NEUTRAL] OK, alright, I can help you with claims and what is that policy number that we're looking at today?
[CUSTOMER][NEUTRAL] What is that policy number
[CUSTOMER][NEUTRAL] Yeah, I'm thinking for the policy number 02446555.
[AGENT][NEUTRAL] 0244655. Is that correct?
[CUSTOMER][NEUTRAL] It is 465-553-5.
[CUSTOMER][NEUTRAL] 3 consecutive 5s.
[AGENT][NEUTRAL] OK, and how do you
[AGENT][NEUTRAL] OK, let me see that it comes up in our system. I'm sorry, I'm having a little trouble with my phone. I just wanna make sure that I'm understanding you correctly and the insured's name and date of birth, please?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] the date.
[CUSTOMER][NEUTRAL] Yeah, I'm calling from Daniel Island Island Dermatology and the member name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII]?
[AGENT][NEUTRAL] Thank you. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, our callback number is [PII] with the extension of [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] [PII] thank you very much. Now what is that policy uh that data service that we're looking for for uh Jacob?
[CUSTOMER][NEUTRAL] service.
[CUSTOMER][NEUTRAL] Yeah, I'm looking for [PII] with the bill amount of $204.38. Could you please spell your name for me?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] Yes,
[AGENT][NEUTRAL] OK, let me just see what we have here.
[CUSTOMER][POSITIVE] Mhm, thank you for that.
[CUSTOMER][NEUTRAL] Yeah, on this claim, the claim has been partially paid and denied the Medicare, primary deductible, BCBS deductible. I'm checking for that. As per the claim has been denied for the same reason and claim sent back for the process and the claim has been paid.
[AGENT][NEUTRAL] OK, so I'm showing that on [PII], there's only one claim.
[CUSTOMER][NEUTRAL] OK, so I'm showing.
[CUSTOMER][NEUTRAL] [PII]. That is [PII]. Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm showing one claim and it looks like that claim was paid so let me look at this and and see if we're looking at the same.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It it looks like
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Mhm. You have paid only $15 on this claim. You have denied the medi uh primary deductible with $53.
[AGENT][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Let me, let me just pull up the claim and see cause I don't show that anything was denied, but let me just see if, if, uh, what is going on with this. Excuse me just a moment, please.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm, OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what I'm doing right now is I'm just pulling up the claim itself that we've received and we'll just go over the EOB and and the claim that we have. OK, so we do show that uh a claim for $204.38.
[CUSTOMER][NEUTRAL] See
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] So we do
[CUSTOMER][NEUTRAL] 4.
[AGENT][NEUTRAL] What, uh, what I show.
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] Uh, there's an additional, uh, deductible amount of $53. Now, that was not, um,
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] That was not denied uh what happened uh there that they just didn't add it uh to the to the claim and so what I'm going to do is I'm going to send the claim back so that this additional $53 will be paid. So this is an error on our part.
[CUSTOMER][NEUTRAL] I uh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The 53.
[CUSTOMER][POSITIVE] OK, good. Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, could you please send the client back for the process? Yeah, go ahead.
[AGENT][NEUTRAL] Uh, I'm sorry, please go ahead.
[AGENT][NEUTRAL] Yes, I'm going to send the send the claim back to be reprocessed and uh then we uh we can get that additional $53 to you, but that is what has happened on this uh on this clinic.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Profit and you can get that additional 53.
[CUSTOMER][NEUTRAL] But that is for the uh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now is this the only claim that we're looking at? Is this the only one that needs to be uh adjusted?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes. Once that has been sent back for repro, may I know the call reference number?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm sorry, excuse me, is this the only claim that we need to adjust? Is, is there another claim that I need to look at?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what is that data of service, please?
[CUSTOMER][NEUTRAL] No, this is the only claim I'm having here. This is the only claim I'm having here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. Once the process has been sent.
[AGENT][NEUTRAL] OK, well then you.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] May I know the call reference number?
[AGENT][NEUTRAL] My name is [PII]. The first letter of my last name is [PII]
[CUSTOMER][NEUTRAL] My name
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] As in kite. We'll use that today's date as a reference, and you should be receiving the payment within 8 to 10 business days and that will be.
[CUSTOMER][NEUTRAL] Is it time would you like?
[CUSTOMER][NEUTRAL] With
[AGENT][NEUTRAL] That will be uh repaid.
[CUSTOMER][POSITIVE] Thank you for that.
[CUSTOMER][POSITIVE] Mhm. Thank you for that, [PII]. Thank you for your assistance. Have a nice day.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you very much for contacting ATO have a very good day.
[CUSTOMER][POSITIVE] OK, thank you very