AccountId: 011433970860
ContactId: 4949eb78-def3-40cf-938f-19984a370ef2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 200160 ms
Total Talk Time (AGENT): 56569 ms
Total Talk Time (CUSTOMER): 60326 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/4949eb78-def3-40cf-938f-19984a370ef2_20250404T20:56_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi there. My name is [PII] calling from the provider's office, and I'm checking on the claim status.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, uh, the callback number is [PII].
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yeah. Uh, it's 024.
[CUSTOMER][NEUTRAL] 402
[CUSTOMER][NEUTRAL] 31
[CUSTOMER][NEUTRAL] M as in Mary. L as in Lima. 8.
[AGENT][NEUTRAL] And the patient name and date of birth?
[CUSTOMER][NEUTRAL] The patient is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And what was the date of service?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And the bill charges?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The amount is
[CUSTOMER][NEUTRAL] $2011 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, it looks like we received that on.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that was denied on [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Uh, looks like they've met the outpatient calendar year maximum.
[CUSTOMER][NEUTRAL] OK, so this is going to be a member's responsibility.
[AGENT][NEUTRAL] Um, we're a secondary policy, so we don't determine patient responsibility.
[CUSTOMER][NEUTRAL] Yeah. So, um, primary was Cigna and they left a co-insurance of $500 which was billed to APL.
[AGENT][NEUTRAL] OK, yeah, I, I, I can just tell you how we process the claim. I can't tell you to bill the patient.
[CUSTOMER][NEUTRAL] OK, got it. May I have the claim number?
[AGENT][NEUTRAL] The claim number is 3559346.
[CUSTOMER][NEUTRAL] OK. And
[CUSTOMER][NEUTRAL] Um, I can get the EP from the portal, right, using this claim number?
[AGENT][POSITIVE] Yes, you can. Uh-huh.
[CUSTOMER][NEUTRAL] OK, and may I have the reference number for this call?
[AGENT][NEUTRAL] Uh, reference number is just my first name, [PII], and then first initial last name D as [PII], and today's date.
[CUSTOMER][POSITIVE] OK, then thank you so much, [PII], and have a good day.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a good day.