AccountId: 011433970860
ContactId: 38524211-8a22-4da3-8c4e-6af409db5cc7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 368799 ms
Total Talk Time (AGENT): 115066 ms
Total Talk Time (CUSTOMER): 93816 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/38524211-8a22-4da3-8c4e-6af409db5cc7_20250618T17:11_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello, thank you for calling APL. This is [PII]. How can we help you?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. Can you please help me with the claim status?
[AGENT][NEUTRAL] Yes, I can check on a claim for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. The callback number is [PII].
[AGENT][NEUTRAL] Thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] Mm, yeah. The policy number, give me a moment. Let me pull up.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. The policy number is 02260485.
[AGENT][NEUTRAL] OK and uh what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Member name is uh
[CUSTOMER][NEUTRAL] [PII] uh sorry, [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that and what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Uh, for this, uh, member, the date of service is [PII] with the charge amount, uh, $1,432.68.
[AGENT][NEUTRAL] OK, that was [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, um, do you have the tax ID for this provider, [PII]?
[CUSTOMER][NEUTRAL] Sure, the tax ID I have and the ID is [PII].
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][POSITIVE] So bear with me just a moment I appreciate your patience.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and just to clarify, you did say that bill amount was $1,432.68?
[CUSTOMER][NEUTRAL] Mm, yes.
[AGENT][NEUTRAL] OK, so the only claim I have on file for this state of service for this uh from this provider, the total bill charges we received were $143,268 even.
[AGENT][NEUTRAL] Could that period have been misplaced?
[CUSTOMER][NEUTRAL] Uh, let me see. Give me a moment.
[CUSTOMER][NEUTRAL] OK, no issue. Can you please give me uh the status of that?
[AGENT][NEUTRAL] Yes, so there were, um, two procedure codes, um, we did pay on one of those that was $401.45. The other procedure we were unable to pay a benefit on.
[AGENT][NEUTRAL] I can give you the specific codes if you need that.
[CUSTOMER][NEUTRAL] Uh, why?
[AGENT][NEUTRAL] So the procedure code that we did pay was uh the denial reason.
[CUSTOMER][NEUTRAL] And I just want to know the reason.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, it states that the insured's major medical coverage provided full benefits, so there were no benefits payable for that procedure.
[CUSTOMER][NEUTRAL] OK. It means this is already paid by the primary insurance, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Thank you for the information and as you stated, the uh the procedure code 52356 was uh was already paid uh in the loud amount $401.45 right?
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. Uh, can you please fax the your review of this claim?
[AGENT][NEUTRAL] Of course, uh, what was that fax number for you?
[CUSTOMER][NEUTRAL] The fax number is [PII].
[AGENT][NEUTRAL] OK, I'm going to read that back to make sure I heard that correctly that was [PII].
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] OK, I'll go ahead and get that sent now. I should get it within about 10 minutes or so. Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Uh, no, thank you. Can you please share me the call reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh my name is spelled [PII]
[CUSTOMER][POSITIVE] OK. Thank you, sir, for helping me for the day and have a great time.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.