AccountId: 011433970860
ContactId: 5327aa2d-29de-489e-a9d6-22d8ec81cffb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 306079 ms
Total Talk Time (AGENT): 112073 ms
Total Talk Time (CUSTOMER): 93191 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/5327aa2d-29de-489e-a9d6-22d8ec81cffb_20250619T12:37_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I'm calling on behalf of the provider's office to check on the general claim status, and could you please help me with that?
[AGENT][NEUTRAL] OK, [PII], you're needing to check claim status for, is it for one claim or do you have more than one claim?
[CUSTOMER][NEUTRAL] Just one.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and [PII], how many, I'm sorry, what is your callback number please?
[CUSTOMER][NEUTRAL] Callback number was [PII] and it is a direct line.
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um, sure. The member's policy ID was 02506178.
[AGENT][NEUTRAL] OK, 02506178. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] And any information [PII] that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name was [PII], and date of birth was on [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And what is the date of service and total bill amount for her place?
[CUSTOMER][NEUTRAL] The service was on [PII] and total bill amount was $20,270 even. And the, the, could you please check with this amount that was uh clarified again that is $19,942 even.
[AGENT][NEUTRAL] OK, well, for the same day service.
[AGENT][NEUTRAL] So there were 2 different billed amounts for that data service, is that what you're stating, [PII]?
[CUSTOMER][NEGATIVE] No, no.
[CUSTOMER][NEUTRAL] No, there was only one date, uh, I'm sorry, this is actually the secondary, and the, the what I stated was the primary bill amount and the secondary bill amount was $19,942 even. That's the only amount that for the state of service.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I do show that this claim was received and um the received date was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It was processed on [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The claim number is 359.
[AGENT][NEUTRAL] 3451.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And this claim shows is being denied due to insured's primary insurance provided full benefits. There are no benefits payable.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Um, may I know why there are no benefits payable because the, the policy was exhausted?
[AGENT][NEUTRAL] It shows that the primary insurance paid full benefits.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] And [PII], if you need a copy of that explanation of benefits, you should be able to print that by going to our portal which is located at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] A excuse me, [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Alright, and thank you so much for your assistance. I've noted that and you have a great day.
[AGENT][POSITIVE] Well, you're very welcome. Is there anything else that, oh, well, thank you very much, [PII] if that's all I can help you with. I hope you have a nice day as well. And thank you again for calling APL.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.