AccountId: 011433970860
ContactId: 48e7d84c-f2e1-4b4e-bd54-642d751f0dc6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 389200 ms
Total Talk Time (AGENT): 148004 ms
Total Talk Time (CUSTOMER): 118661 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/48e7d84c-f2e1-4b4e-bd54-642d751f0dc6_20241231T17:58_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. My name is [PII] to get the claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status in case this call is disconnected. May I have your callback number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The contact number is [PII] and it's a direct line.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And No, may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes. So, the patient ID is [PII] Mary, [PII] in Lima, number 8.
[AGENT][NEUTRAL] Thank you, and that was [PII] ML 8?
[CUSTOMER][POSITIVE] ML 8. That's right.
[AGENT][NEUTRAL] Thank you. And No, may I have the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Sure. The patient name is
[CUSTOMER][NEUTRAL] A ready. The date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the date of service and the bill amount of the claim, please?
[CUSTOMER][NEUTRAL] Uh 722 [PII]. And the total is $658 even.
[AGENT][NEUTRAL] Thank you, so that's for data service of [PII] for $658.
[CUSTOMER][NEUTRAL] Yes, it's $58 even.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, I sure we did receive that claim recently. It looks like we received it on [PII]. It was processed on [PII] as a duplicate claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Looks like we previously received this claim initially on, looks like we initially received this claim on [PII]. It was processed on [PII]. Nothing was paid on this claim because the the policy does not cover office visits or services in the doctor's office. Would you like the claim number?
[CUSTOMER][NEUTRAL] So, can I get these? Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh yes, can I get the claim number?
[AGENT][NEUTRAL] Yes, that number is 349-7472.
[CUSTOMER][NEUTRAL] So let's make sure it's 349-7472, right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK, so in this case what we can do so we can build this patient or?
[AGENT][NEUTRAL] We don't have any involvement in, in your handling of any remaining claims amounts, that's up to your determination. It's not covered under this policy.
[CUSTOMER][NEUTRAL] OK, so do you follow um primary guidelines, right?
[AGENT][NEUTRAL] This coverage is secondary.
[AGENT][NEGATIVE] But it does not cover office visits or services in the doctor's office under their coverage with us. So therefore, no benefits would be payable.
[CUSTOMER][NEUTRAL] Uh yes.
[CUSTOMER][NEUTRAL] OK. So office, this is not covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, in this case
[AGENT][NEUTRAL] Is there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Uh, give me a just just a second.
[CUSTOMER][NEUTRAL] Uh, I think I do have the same patient and different data service. Can you please, uh, help me out today?
[AGENT][NEUTRAL] Yes, what is the data service and build amount?
[CUSTOMER][NEUTRAL] Mhm. 7:30 202024. And the total is
[CUSTOMER][NEUTRAL] Let me double check.
[CUSTOMER][NEUTRAL] $296 even.
[AGENT][NEUTRAL] OK, so it's for data service in [PII] for $296.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] So it looks like we initially received this claim as well on on [PII], processed [PII]. The policy does not cover office visits or services in the doctor's office. That claim number is 3497475.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] 475. Thank you so much. And so the uh mhm uh the next date of service also saying like 7:30-[PII]. Let me check the total charge, one second.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] So you have another day, another charge for 7:30 because you just gave me 7:30 for 296.
[CUSTOMER][NEUTRAL] Yeah, it's um
[CUSTOMER][NEUTRAL] It's a 7:30 and the total charge is $424 even.
[AGENT][NEUTRAL] $424?
[CUSTOMER][POSITIVE] Mhm. Yes, that's right.
[AGENT][POSITIVE] For [PII]. OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] That claim was also received on [PII] and processed on [PII]. The policy does not cover services in the doctor's office. The claim number is 349-7396.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Got it, that's it for today. And uh wonderful and take care. Bye-bye.
[AGENT][POSITIVE] You too, thanks for calling APL bye.