AccountId: 011433970860
ContactId: 3730b4b6-dbc7-4015-9bc0-7f0f0b85fb06
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 245539 ms
Total Talk Time (AGENT): 93457 ms
Total Talk Time (CUSTOMER): 103273 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/3730b4b6-dbc7-4015-9bc0-7f0f0b85fb06_20250212T15:15_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, very good morning. This is [PII] calling from office, and I do have a member and the claim is denied. So here it is showing that the family has paid, then after you, you guys will pay. So I just made this call to get some clarification on the claim. So could you please go ahead and uh assist me with that?
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status. May I have your name?
[CUSTOMER][NEUTRAL] Oh sure. It's gonna be [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And last initial, [PII].
[AGENT][NEUTRAL] OK, and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] OK, and may I have the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Oh, sure. Why not? Premier physical therapy sports medicine?
[AGENT][NEUTRAL] OK, thank you. And let me have the patient's policy number.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It's gonna be 02542049 M as in Mike, L Lima 8.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] May I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Oh sure. [PII] and total charge amount for this same $300 even.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, let me pull the image.
[AGENT][NEUTRAL] And that was [PII], correct?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Yes, you're right.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] I'm waiting on the image to hold up.
[CUSTOMER][POSITIVE] Oh, sure. Take your time.
[CUSTOMER][NEUTRAL] You said your name is [PII]?
[AGENT][NEUTRAL] You too
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Oh, I'm so sorry.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Last initial
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, we have some initial.
[AGENT][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] Alright, just a moment.
[AGENT][NEUTRAL] OK, so, um, this is one of our secondary supplemental plan to the major medical and we only pay if the major medical pay and apply towards the deductible co-payment and co-insurance. If the major medical denied, we deny the claim. So, basically, based on the explanation of benefits from the primary insurance received, the major medical did not pay. So we need um something showing that they did pay for us to take action.
[CUSTOMER][NEGATIVE] So major medical denied this claim stating that a maximum benefit has been met in that condition, you guys will not pay.
[AGENT][NEUTRAL] Correct. If they don't pay, we don't pay. We follow primary.
[CUSTOMER][NEUTRAL] OK. If they're going to, oh sure, if they're going to process the claim, going to apply to us member responsibility like co-pay, deductible or co-insurance, then after you guys will consider for a payment, right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][POSITIVE] Oh, thank you so much for that information. I really appreciate that, so. And uh before wrapping up this call, could you please provide me call reference number?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will, Mr. [PII]. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Oh, no, so that's all for today and have a wonderful day ahead. Bye.
[AGENT][POSITIVE] You as well. Thank you for calling ATM. bye-bye.