AccountId: 011433970860
ContactId: 72103aa0-20f6-4126-8136-c8792ac39f96
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 694409 ms
Total Talk Time (AGENT): 171719 ms
Total Talk Time (CUSTOMER): 307655 ms
Interruptions: 4
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/72103aa0-20f6-4126-8136-c8792ac39f96_20250515T15:48_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][POSITIVE] And thank you for calling
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. I'm calling from the office. May I know the status of claim?
[AGENT][NEUTRAL] And can you spell your name for me?
[CUSTOMER][NEUTRAL] Uh, that is [PII] for
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm sorry, I still didn't understand it. [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mm mm mm [PII].
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Yes, yes, that one.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] And do you have a phone number I can get in case we get disconnected I can call you back.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK. That's [PII].
[CUSTOMER][NEUTRAL] Mm mm.
[AGENT][NEUTRAL] And do you have a policy number?
[CUSTOMER][NEUTRAL] Mm OK. Wait a moment.
[CUSTOMER][NEUTRAL] Policy number is 01849108.
[CUSTOMER][NEUTRAL] Mm mmm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mm mm mm.
[CUSTOMER][NEUTRAL] Mm mm.
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] That was the.
[CUSTOMER][NEUTRAL] Mm, that is [PII].
[AGENT][NEUTRAL] What was the patient's name?
[CUSTOMER][NEUTRAL] That's [PII]
[CUSTOMER][NEUTRAL] Medicine.
[AGENT][NEUTRAL] And the day
[AGENT][NEUTRAL] And the date of birth.
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] Thank you, [PII], you were just needing claim status?
[CUSTOMER][POSITIVE] Thank you and you were just.
[CUSTOMER][NEUTRAL] Yes, yes, I want to know the status of claim. Basically, the thing is that, uh, I want to know the uh reason of denial. So can you uh help me with that?
[AGENT][NEUTRAL] I can help you with that. What date of service?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. So date of service is uh that's uh [PII].
[AGENT][NEUTRAL] OK, I can't hardly hear you. What was it again?
[CUSTOMER][NEUTRAL] I I can
[CUSTOMER][NEUTRAL] Mm mm. What is?
[AGENT][NEUTRAL] What's the date of service again?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], no, no. That's [PII].
[CUSTOMER][NEUTRAL] Mhm mm.
[AGENT][NEUTRAL] OK. Was it [PII]?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Yes, yes, that's correct.
[CUSTOMER][NEUTRAL] Mm mm mm mm.
[AGENT][NEUTRAL] And what's the one of the procedure codes on that bill?
[CUSTOMER][NEUTRAL] What one?
[AGENT][NEUTRAL] What is the procedure code?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Procedure code.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That's a different, different procedure, no. There's a different, different CPT. There's [PII]. What is the status of name? Can you get me?
[AGENT][NEUTRAL] I'm trying to help you. Hold on one moment.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Mm mm mm mm OK.
[CUSTOMER][NEUTRAL] Mm mm.
[AGENT][NEUTRAL] OK, we did get the claim in.
[CUSTOMER][NEUTRAL] OK, we did get the claim in.
[AGENT][NEUTRAL] Office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] A bit more office visit.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] But for the office visit.
[CUSTOMER][NEGATIVE] It's not covered.
[CUSTOMER][NEUTRAL] Cover under the policy, under the plan then? Mm mm mm.
[AGENT][NEUTRAL] And the 170001.
[CUSTOMER][NEUTRAL] 7001.
[AGENT][NEUTRAL] Uh, major medical paid in full.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What, what, what? Medicare?
[AGENT][NEUTRAL] Major medical paid in full.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can you spell for all?
[AGENT][NEUTRAL] Major.
[AGENT][NEUTRAL] Medical.
[CUSTOMER][NEUTRAL] MEGO
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK. Medical.
[AGENT][NEUTRAL] They
[CUSTOMER][NEUTRAL] Then
[AGENT][NEUTRAL] P A I D.
[CUSTOMER][NEUTRAL] Uh, what is that?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In full.
[CUSTOMER][NEUTRAL] [PII] then?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] F U L L.
[CUSTOMER][NEUTRAL] in
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's for both 17,000 and 17003.
[CUSTOMER][NEUTRAL] In
[CUSTOMER][NEUTRAL] Just for the same.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mm. Uh, for office visit is not covered under the plan for the CPT. That's for the one CPT, no? For CPT that is.
[AGENT][NEUTRAL] 992003.
[CUSTOMER][NEUTRAL] 99203, no.
[CUSTOMER][NEUTRAL] OK. So what I do right now?
[AGENT][NEGATIVE] I didn't understand it.
[CUSTOMER][NEUTRAL] So, uh, so, uh, wait a moment.
[CUSTOMER][NEUTRAL] Uh, for the one CPT 700197003, what is the demand?
[AGENT][NEUTRAL] Major medical paid in full.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Info.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK. Wait a moment. OK. Let me check in now. Can I hold on for one minute for the the information and the information?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you. But
[CUSTOMER][NEUTRAL] Uh hello, are you there?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Can you, uh, clarify, uh, what is the actual, um, denial reason because I can't understand what you said. I have, uh, note on all the things there. So, uh, if I, um, uh, if I note down, uh, incomplete things, so it is another, uh, again denial. So can you share all the information? What is the major medical paid info? Can you guide me accordingly?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, they have another major medical insurance, their primary insurance.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] And I.
[AGENT][NEUTRAL] Paid the claim in full.
[CUSTOMER][NEUTRAL] They have?
[AGENT][NEUTRAL] So we have nothing else left to pay.
[CUSTOMER][NEUTRAL] They have
[CUSTOMER][NEUTRAL] Can you repeat again, ma'am?
[AGENT][NEUTRAL] The primary insurance paid in full.
[CUSTOMER][NEUTRAL] The prime.
[CUSTOMER][NEUTRAL] OK info. So what is that?
[AGENT][NEUTRAL] That's all I know to tell you that the client, the bill was paid in full. We don't have anything left to pay.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I didn't.
[CUSTOMER][NEUTRAL] What, what?
[AGENT][NEUTRAL] The primary insurance paid in full.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That's all I know to tell you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] After the info, what, what you tell?
[AGENT][NEUTRAL] This is a secondary policy, not the primary.
[CUSTOMER][NEUTRAL] Secondary.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Their primary already paid the claim.
[CUSTOMER][NEUTRAL] The the.
[CUSTOMER][NEUTRAL] OK. As I understand the primary, uh, primary already pay as I check the, uh, system. There's a denial. Uh, so what is the uh reason behind the denial? I want to know that information only.
[CUSTOMER][NEUTRAL] Mm mm mm.
[AGENT][NEUTRAL] I done told you 3 times. I don't know what else to tell you.
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] Mm, basically, thing is that, no. OK, as I checked there, there's a denial, there's non-covered deny. OK. So I want to know what is the non-covered deni and what I do for that.
[AGENT][NEUTRAL] Primary paid in full. That's all I can tell you, primary insurance paid in full.
[CUSTOMER][NEUTRAL] They paid in in.
[CUSTOMER][NEUTRAL] OK. So what I do and I know in this uh case.
[CUSTOMER][NEUTRAL] Can I be the patient?
[AGENT][POSITIVE] Yes, you can.
[CUSTOMER][POSITIVE] Yes you can.
[CUSTOMER][NEUTRAL] And what is the code reference number?
[AGENT][NEUTRAL] We do not have call reference numbers. You can use my name in today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, can you spell your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Last initial is [PII].
[CUSTOMER][NEUTRAL] The.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][POSITIVE] Thank you, [PII] for calling ATL. You have a good day.
[CUSTOMER][NEUTRAL] Bye.