AccountId: 011433970860
ContactId: 461c38d5-d516-4476-bb4f-a76e9a86c15d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 403339 ms
Total Talk Time (AGENT): 125146 ms
Total Talk Time (CUSTOMER): 126039 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/461c38d5-d516-4476-bb4f-a76e9a86c15d_20250227T18:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from office for claim denial reason.
[AGENT][NEUTRAL] OK, yeah, I can look at a claim for you. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] So, got it, thank you. And then, uh, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] and my extension number is [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Is that is 0234 0562.
[AGENT][NEUTRAL] OK. And uh what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] The first name is [PII] and the last name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. And then do you have the claim number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] You know, I have the claim number. I'm not having a claim number.
[AGENT][NEUTRAL] OK, uh, what was the date of service?
[CUSTOMER][NEUTRAL] The date of service is [PII].
[AGENT][NEUTRAL] I'm sorry, that was [PII]?
[CUSTOMER][NEUTRAL] It's correct [PII].
[AGENT][NEUTRAL] OK, and then that bill amount please.
[CUSTOMER][NEUTRAL] $255 even.
[AGENT][NEUTRAL] I'm sorry, could you repeat that amount, [PII]?
[CUSTOMER][NEUTRAL] $255 even.
[AGENT][NEUTRAL] 253.
[CUSTOMER][NEUTRAL] 255
[AGENT][NEUTRAL] 0, 255. OK.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] All right, one moment please.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so for this claim, we did pay a benefit of $75 and that was the maximum amount payable for the state of service.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you need the claim number?
[CUSTOMER][NEUTRAL] One moment, I will note it down.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Could you share the payment number?
[AGENT][NEUTRAL] Yes, that's 3,558,420.
[CUSTOMER][NEUTRAL] I repeat that 3,558,420, is that correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Could you share your name with spelling?
[AGENT][NEUTRAL] My name is uh [PII]
[CUSTOMER][NEUTRAL] Could you share your last name please?
[AGENT][NEUTRAL] Last initial is [PII]
[CUSTOMER][NEUTRAL] OK, um, more CDs were paid, uh, the other CPT 87,880. May I know the reason of that.
[AGENT][NEUTRAL] The $75 that went towards the other procedure code that was simply the maximum amount payable for the date of service.
[AGENT][NEGATIVE] So the the benefit amount had been exhausted, so we were unable to pay uh pay additional.
[CUSTOMER][NEUTRAL] OK, I did the benefit amount is $75 only, right?
[AGENT][NEUTRAL] 75, yes.
[CUSTOMER][NEUTRAL] The remaining is patient responsibility.
[AGENT][NEUTRAL] We do not say what is patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] Oh, OK, it is the right of flight.
[AGENT][NEUTRAL] Uh, it's up to the provider whether or not it is patient responsibility.
[CUSTOMER][NEUTRAL] It's applied towards contractual provided right of right.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] It's up to the provider we don't say what is patient responsibility.
[CUSTOMER][NEUTRAL] Mhm this is not patient responsibility, right?
[AGENT][NEUTRAL] We do not say if it is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] Could you please fax a copy of the evening.
[AGENT][NEUTRAL] Sure, what's that fax number for you?
[CUSTOMER][NEUTRAL] Yeah, sure, it is [PII]. Attention to [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm gonna read that back to make sure I heard that correctly. That was [PII].
[CUSTOMER][POSITIVE] It's correct.
[AGENT][POSITIVE] OK, I will get that sent to you. Was there anything else I could help you with?
[CUSTOMER][NEUTRAL] No, could you share the call reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII]
[CUSTOMER][NEUTRAL] For the same
[CUSTOMER][NEUTRAL] I repeat that name spelled as [PII], right?
[AGENT][NEUTRAL] Yes, [PII] A R A, Kilo Alpha Romeo Alpha.
[CUSTOMER][NEUTRAL] OK, may I know when you'll be received by fax?
[AGENT][NEUTRAL] Uh, you should get it here in maybe 10 to 15 minutes.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][POSITIVE] OK, thank you for listening. Have a great day. Bye bye.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.