AccountId: 011433970860
ContactId: 5f233912-5109-4c0e-a48c-68cdada3a1e3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 464880 ms
Total Talk Time (AGENT): 103910 ms
Total Talk Time (CUSTOMER): 118705 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/5f233912-5109-4c0e-a48c-68cdada3a1e3_20250603T17:50_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII], this is [PII] and I'm calling for claims.
[AGENT][NEUTRAL] And you said your name was [PII]?
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh, sure, it's [PII]. That is the direct line.
[AGENT][POSITIVE] Great. And can I have the policy number for the claim?
[CUSTOMER][NEUTRAL] Uh sure, the policy number of the patient is 02463395.
[AGENT][NEUTRAL] Alright, give me just a moment to look that up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] for
[AGENT][NEUTRAL] And can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] And do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Do you have the claim number or the date of service?
[CUSTOMER][NEUTRAL] Or provider
[CUSTOMER][NEUTRAL] Oh, I'm sorry, I was on mute. I provided the date of service uh [PII] Bill the.
[CUSTOMER][NEUTRAL] $1,079.50.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And you said [PII], correct?
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] OK, it looks like we received this claim on [PII].
[AGENT][NEUTRAL] It was processed on [PII].
[AGENT][NEUTRAL] Would you like the claim number?
[CUSTOMER][NEUTRAL] Uh, yeah, actually, uh, um, I think I've got the claim number is the same number, uh.
[CUSTOMER][NEUTRAL] 3592853
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] And it looks like we paid.
[CUSTOMER][NEUTRAL] OK, it's just I don't have the copy of explanation of benefits. I just need to know is there any denial on the claim because we are actually underpaid.
[CUSTOMER][NEUTRAL] So is there any denial on the claim?
[AGENT][NEUTRAL] Um, it looks like with the payment of the check that we sent, yeah, it looks like the, the, the payment that we sent was, um, with that payment, uh, the policy maximum for that benefit has been met.
[CUSTOMER][NEGATIVE] Like partial denial, and denial.
[AGENT][NEUTRAL] So what we paid is all that they had left for that benefit for the calendar year.
[CUSTOMER][NEUTRAL] OK, so you already paid max amount of $987.19 right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So is there any like uh patient responsibility?
[AGENT][NEUTRAL] So we don't determine patient responsibility, that will be up to the provider.
[CUSTOMER][POSITIVE] OK, thank you for that.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] What.
[CUSTOMER][NEUTRAL] Yep, uh, I just need the reference number of the call.
[AGENT][NEUTRAL] OK, so we don't have reference numbers but you can use my name.
[CUSTOMER][POSITIVE] Oh, as well as sorry
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] What was that?
[CUSTOMER][NEUTRAL] OK, we will use your first name and the date. Uh, I just wanna ask because we haven't received the explanation of benefits that can you uh resend it to us like fax it.
[AGENT][NEUTRAL] You want me to fax it to you? Give me just a second.
[AGENT][NEUTRAL] Give me one moment while I pull it up.
[AGENT][NEUTRAL] OK give me one moment while I get ready to fax this to you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And what is a good fax number?
[CUSTOMER][NEUTRAL] The fax number is [PII].
[AGENT][NEUTRAL] And just to confirm.
[AGENT][NEUTRAL] I have [PII].
[AGENT][NEUTRAL] 803.
[AGENT][NEUTRAL] 4786, correct?
[CUSTOMER][POSITIVE] Exactly.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I just sent that fax over to you.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] 789.
[CUSTOMER][POSITIVE] Mhm perfect.
[AGENT][NEUTRAL] Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] I know that will be all.
[AGENT][POSITIVE] Right. Thank you for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] Yeah, so bye bye.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have.