AccountId: 011433970860
ContactId: 582bf815-71f0-424a-9725-29d704a2747a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 850520 ms
Total Talk Time (AGENT): 202331 ms
Total Talk Time (CUSTOMER): 95886 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=-1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/582bf815-71f0-424a-9725-29d704a2747a_20250320T13:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I'm checking on um a claim please.
[AGENT][NEUTRAL] OK, are you calling with the provider's office?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK um.
[AGENT][NEUTRAL] Can I get your name and a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what was your name?
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]? OK, thank you.
[AGENT][NEUTRAL] Let me get into our system real quick.
[AGENT][NEUTRAL] Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] 02419768.
[CUSTOMER][NEUTRAL] ML 7.
[AGENT][NEUTRAL] Do you have the patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then [PII], did you say I'm sorry did you say claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What's that data service?
[CUSTOMER][NEUTRAL] Uh, the first one is for 102.
[CUSTOMER][NEUTRAL] Through [PII] of 2024.
[CUSTOMER][NEUTRAL] $1,554.
[CUSTOMER][NEUTRAL] And it looks like I'm calling on the 2 office visits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And who is that provider?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Let's see.
[AGENT][POSITIVE] Sorry, I'm looking at this. Thank you for your patience.
[AGENT][NEUTRAL] Um, it looks like office visits aren't covered under the policy.
[CUSTOMER][NEUTRAL] OK, and that's um for the patient's policy?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you have another day of service?
[CUSTOMER][NEUTRAL] Uh, there is, is there a claim number for this one?
[AGENT][NEUTRAL] Uh, that claim number is 3561695.
[CUSTOMER][NEUTRAL] OK, and um they'll be under the same reference number?
[AGENT][NEUTRAL] Yeah, the reference number is just my first name [PII], last initial [PII], and then today's date.
[CUSTOMER][NEUTRAL] OK, and whenever you're ready for the next uh data service.
[AGENT][NEUTRAL] OK, let me get that pulled up.
[AGENT][NEUTRAL] OK, what's that data service please?
[CUSTOMER][NEUTRAL] 111 $2024706.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, looks like
[AGENT][NEUTRAL] We pay the benefits for this directly to the insured.
[CUSTOMER][NEUTRAL] OK, and how much was paid to the patient?
[AGENT][NEUTRAL] Uh, looks like.
[AGENT][NEUTRAL] It says paid to the insured, but I don't see a payment. Let me look at that again.
[AGENT][NEUTRAL] That was 11 124 for 706, is that right?
[CUSTOMER][NEUTRAL] 1124 so yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Says paid to the patient, but I don't see a payment.
[AGENT][NEUTRAL] Let's see what type of service was that for?
[CUSTOMER][NEUTRAL] Uh, physical therapy.
[AGENT][NEUTRAL] Physical therapy, let me see if that's covered.
[AGENT][NEUTRAL] Maybe they put the in correct denial code.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] Yeah, I don't see physical therapy benefits on here, so.
[AGENT][NEGATIVE] Looks like it wasn't covered.
[AGENT][NEUTRAL] Um, do you need that claim number as well?
[CUSTOMER][NEUTRAL] Um, yes, claim number please.
[AGENT][NEUTRAL] 3561685.
[CUSTOMER][NEUTRAL] OK, and what was the end determination of that data service?
[AGENT][NEGATIVE] Uh, it looks like there was no benefits for that.
[CUSTOMER][NEUTRAL] OK, so the remaining balance is patient responsibility?
[AGENT][NEUTRAL] Correct, if, if it's already been processed by the primary insurance.
[CUSTOMER][NEUTRAL] Yeah it looks like the primary put it towards uh.
[CUSTOMER][NEUTRAL] The deductible.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So is that going to the patient's deductible or?
[AGENT][NEUTRAL] Well, we're we're just a secondary policy so we don't really determine patient responsibility.
[AGENT][NEUTRAL] Let me look at one other thing real quick if you don't mind.
[AGENT][NEUTRAL] Let me see
[AGENT][NEUTRAL] was
[AGENT][NEUTRAL] Double checking one other thing. Sorry about the wait.
[AGENT][NEUTRAL] Do you mind if I place you on a brief hold? I'm gonna look at something real quick, OK?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey.
[AGENT][NEUTRAL] I, I don't understand the denial on this.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, is that, well, one says 101, no, that's right. OK, I see. Is that the 356.
[AGENT][NEUTRAL] 61448.
[AGENT][NEGATIVE] I'm feeling frustrated.
[AGENT][NEGATIVE] I'm sale on earth
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, we don't
[AGENT][NEUTRAL] I see the 6 69741.
[AGENT][NEUTRAL] Yes.
[AGENT][NEGATIVE] Is that right? Am I looking at this right? No, it's not right.
[AGENT][NEUTRAL] That's what I've got.
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I did
[AGENT][NEUTRAL] OK, I'm sorry yeah I'm trying to navigate everything um so what do I say now to her? Did you hear what I said? I was like, OK.
[AGENT][NEUTRAL] OK, OK.
[AGENT][POSITIVE] OK, perfect. I'll let her know then.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 1685.
[AGENT][POSITIVE] OK, OK, perfect. OK, thank you.
[AGENT][POSITIVE] OK, perfect, thank you.
[AGENT][NEUTRAL] OK sorry about that [PII], thanks for holding um I I was trying to get clarification on what exactly was transpiring so it does look like we did pay the insured, but you'll have to reach out to them um to discuss what they received because we we don't disclose that information so um I did I give you the claim number? I'm sorry.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yeah
[AGENT][NEUTRAL] Yeah, the 356-1685, so as I said it was paid to the insured and then if you'll reach out to them and um discuss that claim with them.
[CUSTOMER][POSITIVE] OK all right thank you.
[AGENT][POSITIVE] OK, thank you. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, no, that's it.
[AGENT][POSITIVE] OK, thank you, [PII] have a great day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Mm bye.