AccountId: 011433970860
ContactId: 3d224539-1434-4ca9-94a7-eb31b167a78c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 843679 ms
Total Talk Time (AGENT): 165586 ms
Total Talk Time (CUSTOMER): 150300 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/3d224539-1434-4ca9-94a7-eb31b167a78c_20250617T17:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and my last initial is [PII]. And I just need the claim status. So, can I help you with that?
[AGENT][NEUTRAL] I can help you with claim status. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. My callback number is [PII] and my extension is [PII].
[AGENT][NEUTRAL] And do you have the policy number with you?
[CUSTOMER][NEUTRAL] Yes, uh, the policy number is 02555967.
[AGENT][NEUTRAL] 02555967
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, give me just one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] Uh, my first name is [PII] and the last name is [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Thank you so much for verifying that with me.
[AGENT][NEUTRAL] Do you have the claim number or the date of service?
[CUSTOMER][NEUTRAL] Uh yes, I have the date of service that is uh December 20024 with the charge on $35 even.
[AGENT][NEUTRAL] You said December [PII]?
[CUSTOMER][NEUTRAL] Uh, no, 24, 24.
[AGENT][NEUTRAL] 0, 24th? OK.
[AGENT][NEUTRAL] Give me just one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the provider's name?
[CUSTOMER][NEUTRAL] That is advanced radiology services.
[AGENT][NEUTRAL] And the total bill amount was $25?
[CUSTOMER][NEUTRAL] Uh, no, 35, 35.
[AGENT][NEUTRAL] OK, 35, let me see here.
[AGENT][NEUTRAL] Here we go.
[AGENT][NEUTRAL] OK, give me just a moment while I look for that.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Alright, it looks like that claim was denied because the benefit, the maximum benefit for confinement had already been paid.
[CUSTOMER][NEUTRAL] Uh, maximum benefit.
[AGENT][NEUTRAL] Yes, so it was already paid.
[CUSTOMER][NEUTRAL] OK, so you're saying that the claim was denied because the maximum benefit is already paid, right?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh, so can you provide me the claim received and processed it?
[AGENT][NEUTRAL] Sure, give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Looks like that claim was received on [PII].
[AGENT][NEUTRAL] And it was processed on [PII].
[CUSTOMER][NEUTRAL] OK. And uh to process this claim, uh, we can do anything uh or
[CUSTOMER][NEUTRAL] Uh, we need to bill the member, the remaining amount.
[AGENT][NEUTRAL] Right, the
[AGENT][NEUTRAL] Uh, we don't handle patient responsibility.
[AGENT][NEUTRAL] That's up to the provider.
[CUSTOMER][NEUTRAL] OK, so we cannot do anything for this claim, right? It will not be processed, right?
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct, it's already been processed and it's already been paid um from a previous claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And can you provide me the claim number?
[AGENT][NEUTRAL] The claim number is 3572034.
[CUSTOMER][NEUTRAL] 3572034. OK. And I have some more data service for this member. So can you just help me with that claims also?
[AGENT][NEUTRAL] You have another claim for this number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what's the date of service?
[CUSTOMER][NEUTRAL] That is [PII] with the charge on $35 even.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It looks like this policy, it looks like this claim was received.
[AGENT][NEUTRAL] On [PII], it was processed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that claim was denied for the same reason.
[CUSTOMER][NEUTRAL] OK. It was also denied for the same reason.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK. And can you provide me the claim number?
[AGENT][NEUTRAL] The claim number is 35.
[AGENT][NEUTRAL] 72023
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, and, uh, shall I provide you the next date of service for this member?
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] That is [PII] with the charge amount $35 even.
[AGENT][NEUTRAL] Yes, that claim was denied for the same reason that the benefit had already been paid from a previous claim.
[CUSTOMER][NEUTRAL] OK, so that one is, is also denied for the same reason and the claim received and processed date is also the same.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] I'm sorry, could you repeat that one more time, please?
[CUSTOMER][NEUTRAL] OK. And
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, the claim received and processed rate is also the same for this claim as.
[AGENT][NEUTRAL] Yes, the [PII] and the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the claim number?
[AGENT][NEUTRAL] 3523572023
[CUSTOMER][NEUTRAL] OK, so the claim number is also the same, right?
[AGENT][NEUTRAL] Are you asking for a different date, a third date of service?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Is there any claim for $70 even?
[CUSTOMER][NEUTRAL] 70.
[CUSTOMER][NEUTRAL] For [PII] or [PII].
[AGENT][NEUTRAL] I can look at that just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, the claim number for the 3rd date for $35 is 3572074.
[CUSTOMER][NEUTRAL] And all the information is the same, right?
[AGENT][NEUTRAL] Correct, in the same denial reason.
[CUSTOMER][NEUTRAL] OK, and the last date of service I have that is [PII] with the charge amount $35 even.
[AGENT][NEUTRAL] OK, it looks like that was denied. Oh, you said [PII]. Give me just a moment.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Yes, that one has the same u[PII] claim number 3572074. It was denied for the same reason.
[CUSTOMER][NEUTRAL] OK. And the call reference number for our call?
[AGENT][NEUTRAL] We don't have co reference numbers, but you can use my name and last initial in today's date, so [PII] in today's date.
[CUSTOMER][POSITIVE] OK. So thank you so much for helping me for uh this much claims and uh have a nice day and take care.
[AGENT][POSITIVE] Great, thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.