AccountId: 011433970860
ContactId: 3d5728be-0abb-49fa-8f37-09044180de8a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 435739 ms
Total Talk Time (AGENT): 128058 ms
Total Talk Time (CUSTOMER): 81596 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/3d5728be-0abb-49fa-8f37-09044180de8a_20250303T16:53_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, I'm office to check some claims.
[AGENT][NEUTRAL] OK, I can barely hear you.
[CUSTOMER][NEUTRAL] Sorry for that. My name is [PII], spelled like [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And you said you're calling for claim status?
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] OK, do you have the policy number?
[CUSTOMER][NEUTRAL] Uh yes, the policy ID is 02538043 M as in Mary, L as in Lima 8.
[AGENT][NEUTRAL] And what's a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] or was that [PII]?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII]. OK, thank you. Give me a moment to pull up the file, OK?
[CUSTOMER][NEUTRAL] Yes, of course, uh, what's your name?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] In one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the patient's name and date of birth, [PII]?
[CUSTOMER][NEUTRAL] Uh, it's R0 Julia and date of birth it's [PII].
[AGENT][NEUTRAL] Thank you. And what's the date of service and the total charge?
[CUSTOMER][NEUTRAL] Uh, date of service is [PII] for bill amount $676 even.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] Still checking.
[CUSTOMER][POSITIVE] Let's take your time.
[CUSTOMER][NEUTRAL] Can you just update me that uh the patient is active for data service correct?
[AGENT][NEUTRAL] Yeah, they were active. Give me one second.
[CUSTOMER][POSITIVE] OK, take your time. No issues.
[AGENT][NEUTRAL] So I do show.
[AGENT][NEUTRAL] That the claim was received.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] And processed on [PII].
[AGENT][NEUTRAL] Um, and there was no payment made on this claim?
[AGENT][NEUTRAL] It says that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The policy benefits for the listed dates of service have been paid directly to the insured, so it looks like the insured may have submitted the claim as well to APL prior to receiving this one.
[CUSTOMER][NEUTRAL] What's the claim number?
[CUSTOMER][NEUTRAL] What's the claim number?
[AGENT][NEUTRAL] Uh, your claim number is 355.
[AGENT][NEUTRAL] 4275.
[CUSTOMER][NEUTRAL] That's all?
[AGENT][NEUTRAL] That's the claim number, yes.
[CUSTOMER][NEUTRAL] OK, so it is getting paid or denied?
[AGENT][NEUTRAL] Your claim was denied. Yes.
[CUSTOMER][NEUTRAL] It is denied, correct?
[CUSTOMER][NEUTRAL] OK, so it is uh.
[CUSTOMER][NEUTRAL] Uh, what's the reason?
[AGENT][NEUTRAL] It appears that the claim was submitted by the patient prior to receiving your claim and the payment was issued to the, the payment was issued to the insured.
[CUSTOMER][NEUTRAL] OK, so what we need to do, the uh balance amount is patient responsibility.
[AGENT][NEUTRAL] We cannot advise. We could just tell you the status of the claim and how it was processed.
[CUSTOMER][NEUTRAL] OK, just provide me the call reference number.
[AGENT][NEUTRAL] Um, it's my name in today's date, [PII], first initial last name is [PII]. And did you have any other questions, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, I have one more data service for the patient.
[AGENT][NEUTRAL] And the date of service?
[CUSTOMER][NEUTRAL] It's [PII] for bill amount $676 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You can also check your status online at [PII].
[AGENT][NEUTRAL] And the same with this one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm showing that it looks like the the patient may have submitted the claim and the payment went to the patient.
[AGENT][NEUTRAL] Um, yours was denied for that reason under claim number.
[AGENT][NEUTRAL] 355-4271.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm showing that it was received, your claim was received.
[CUSTOMER][NEUTRAL] OK, so it is
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, OK, just for the.
[AGENT][NEUTRAL] And processed on [PII].
[CUSTOMER][NEUTRAL] OK, it's OK, it's OK.
[CUSTOMER][NEUTRAL] It is denied for the same reason as previous one?
[AGENT][NEUTRAL] Yes.