AccountId: 011433970860
ContactId: 63ce4ea8-185c-4f18-9b9d-6274404769cf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 325339 ms
Total Talk Time (AGENT): 126506 ms
Total Talk Time (CUSTOMER): 65341 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/63ce4ea8-185c-4f18-9b9d-6274404769cf_20250603T15:53_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from provider of claims.
[AGENT][NEUTRAL] How can I help you today, [PII]?
[CUSTOMER][NEUTRAL] Claims, claim status information.
[AGENT][NEUTRAL] Oh, status. Can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] 1,702,710.
[AGENT][NEUTRAL] Can you give me just a moment while I look that up.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] And do you have the claim number or date of service?
[CUSTOMER][NEUTRAL] Yes, the claim number is 3576.
[CUSTOMER][NEUTRAL] 551.
[AGENT][NEUTRAL] And do you know what the provider's name is?
[CUSTOMER][POSITIVE] Sleep Data Holdings better night.
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] It looks like we received this claim on [PII]. It was processed on [PII].
[AGENT][NEUTRAL] And it looks like we
[CUSTOMER][NEUTRAL] Uh, actually, there is
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] There is a denial on two courts. Can you tell me why these codes are denied?
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEGATIVE] It looks like that line item does not meet the definition of durable medical equipment under the policy contract. Uh, therefore, we are unable to provide benefits for that charge.
[AGENT][NEUTRAL] And then let's see what the other one is.
[AGENT][NEUTRAL] It looks like the other denial is the receipt of the claim has been acknowledged, but in order for us to process the claim, we need the explanation of benefits that matches the claim information.
[CUSTOMER][NEUTRAL] OK. Uh, and one more code is 0562.
[CUSTOMER][NEGATIVE] It was underpaid.
[CUSTOMER][NEUTRAL] Could you please check?
[AGENT][NEUTRAL] It looks like this claim for that, uh, the benefits are payable only if the major medical insurance.
[AGENT][NEUTRAL] Provides benefits. Um, so if this claim is later paid by their major medical insurance, you'll need to send a copy of the explanation of benefits showing that benefits were paid.
[CUSTOMER][NEUTRAL] Uh, can you provide me your fax number or mailing address so I can send the UV.
[AGENT][NEUTRAL] Sure, our fax number?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[AGENT][NEUTRAL] And you'll do a pension claims department.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] And then our mailing address?
[AGENT][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] In [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. Can I have your car reference number?
[AGENT][NEUTRAL] We don't have call reference numbers, um, you just use my name and last initial in today's date, so [PII] in today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thank you so much. That's all for today.
[AGENT][POSITIVE] OK. Thank you for calling APL. If there's nothing else, I hope you have a great day.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][NEUTRAL] Bye.