AccountId: 011433970860
ContactId: 6ae29c32-a853-424c-a40f-92509eef841a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 420179 ms
Total Talk Time (AGENT): 85467 ms
Total Talk Time (CUSTOMER): 205633 ms
Interruptions: 2
Overall Sentiment: AGENT=-0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/6ae29c32-a853-424c-a40f-92509eef841a_20250327T19:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from office. This call is regarding to check claim status.
[AGENT][NEUTRAL] OK [PII], I can help you with claim status. Do you have the uh good call back number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 1
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yes, sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, ready? 02.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 02555967
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, what was the, uh, policy number again?
[CUSTOMER][NEUTRAL] 02555967
[AGENT][NEUTRAL] What was the patient name and date of birth?
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You can provide the name of remote 285.
[AGENT][NEUTRAL] The data service?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII].
[CUSTOMER][NEUTRAL] OK that's
[CUSTOMER][NEUTRAL] the
[AGENT][NEUTRAL] 1:30 is 2025.
[CUSTOMER][NEUTRAL] [PII], total bill amount is 30, 234.
[CUSTOMER][NEGATIVE] I need to save money calling from private.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 62.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 4.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And the maximum benefits for this confinement have been previously met.
[CUSTOMER][NEUTRAL] No idea.
[CUSTOMER][NEUTRAL] OK, um, the claim primary paid more than 2 days, correct?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Primary paid more than secondary, correct?
[AGENT][NEUTRAL] We we are secondary. We pay secondary after primary pays.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh, what is the secondary allowance?
[AGENT][NEUTRAL] What is the benefit for this policy? Is that what you're asking?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, hold on one moment. Was this for inpatient services?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What type of services was it for?
[CUSTOMER][NEUTRAL] Could you please verify the dinner reason once again?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] The the denial reason is the one I just stated um.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on, let me pull it back up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, take your time.
[AGENT][NEGATIVE] The denial was the maximum benefits for this confinement have previously been paid.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] No, no. [PII] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What is the allowed amount and paid amount about this previously paid?
[AGENT][NEUTRAL] So for inpatient hospital benefits it only pays $1000 per confinement.
[AGENT][NEUTRAL] And that was paid on another claim.
[CUSTOMER][NEUTRAL] $1000.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. OK. OK. Uh, I've been
[CUSTOMER][NEUTRAL] Patient another date of service.
[AGENT][NEUTRAL] You you have another date of service is that right?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] T as in Total charge amount is $605.
[AGENT][NEUTRAL] Did you say 605, is that correct?
[CUSTOMER][NEUTRAL] So I have one more.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, the problem is [PII] and spend about 224.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEGATIVE] That one was denied for the same reason. $1000 was already paid on another claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, on the next date of study.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] That is same date of service. [PII] and charge amount is 55. OK. uh I have multiple claim for same.
[AGENT][NEGATIVE] Oh, it was denied for the same reason.
[CUSTOMER][NEUTRAL] That is all the same reason?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh, OK. Could you please state your name and call this number for documentation?
[AGENT][NEUTRAL] Uh my name is [PII]. Today's date is the reference.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK. Thank you, [PII].
[AGENT][POSITIVE] All right, thank you, [PII]. Thanks for calling APL. Have a good day. Bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Mm