AccountId: 011433970860
ContactId: 434fd09e-ed17-45bc-9ff1-27bc573618ed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 338049 ms
Total Talk Time (AGENT): 133906 ms
Total Talk Time (CUSTOMER): 83104 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/434fd09e-ed17-45bc-9ff1-27bc573618ed_20250529T13:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] I'm calling from medical specialist of Palm Beach of Florida having questions on patient's claim.
[AGENT][POSITIVE] Sure I can help you with claim status. Can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, [PII] and what was the rest?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And do you have the um policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number for this patient would be?
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] 02473058.
[AGENT][NEUTRAL] Alright, one moment while I look that up for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you so much. And do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, one second, I'll provide you the claim number.
[CUSTOMER][NEUTRAL] Claim number 3588094.
[AGENT][NEUTRAL] OK. One moment.
[AGENT][NEUTRAL] It looks like we received that claim on [PII]. It was processed on [PII].
[AGENT][NEGATIVE] It looks like it was denied and let me see why.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEGATIVE] It looks like it was a duplicate.
[CUSTOMER][NEUTRAL] All right. Uh, one second, I'll provide you the original claim number.
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] One moment. I'll provide you the original claim number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number 3, let me see which one would the duplicate be.
[CUSTOMER][NEUTRAL] Uh, it is um 356-089-98.
[AGENT][NEUTRAL] Do you know what the date of services?
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Can you repeat that [PII] or 35, what?
[CUSTOMER][NEUTRAL] 356-089-98
[AGENT][NEUTRAL] OK, give me just a moment and let me look.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it looks like we received that claim on
[AGENT][NEUTRAL] [PII]. It was processed on [PII].
[AGENT][NEGATIVE] It was denied due to office visits not being covered.
[CUSTOMER][NEUTRAL] Why?
[AGENT][NEUTRAL] Office visits aren't covered under her policy?
[CUSTOMER][NEUTRAL] Offices are not covered under patient's policy.
[AGENT][NEUTRAL] Right, not under this policy.
[CUSTOMER][NEUTRAL] Uh, can you please provide me what things are covered under the patient's policy?
[AGENT][NEUTRAL] Sure, let me pull that up.
[AGENT][NEUTRAL] It looks like and this is just a verification of benefits, not a guarantee of payment. Uh looks like she has an inpatient benefit maximum.
[AGENT][NEUTRAL] Of up to $3000 per confinement.
[AGENT][NEUTRAL] She has an outpatient benefit maximum of up to $300 per calendar day.
[AGENT][NEUTRAL] It looks like these, she's only able to for this policy if it's related to an accident or illness.
[AGENT][NEUTRAL] She also has a durable medical equipment writer and a cancer patient rider, um, so she can get cancer treatment but not the, oh, go ahead.
[CUSTOMER][NEUTRAL] One second.
[CUSTOMER][NEUTRAL] One moment. Accident, illness.
[CUSTOMER][NEUTRAL] DME?
[CUSTOMER][NEUTRAL] Cancer treatment, right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And cancer treatment.
[AGENT][NEUTRAL] There's nothing for office visits.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So this is the patient responsibility, right?
[AGENT][NEUTRAL] Uh, we don't determine patient responsibility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. Call reference number.
[AGENT][NEUTRAL] We don't have call reference numbers, but you can use my name and last initial in today's date, [PII]
[CUSTOMER][NEUTRAL] Can you spell
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], and then today's date.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] All right. Thank you. Thank you so much. Bye-bye.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day.