AccountId: 011433970860
ContactId: 8d265594-06f1-478a-a5a3-e01b7897d340
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 361739 ms
Total Talk Time (AGENT): 79554 ms
Total Talk Time (CUSTOMER): 75000 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.2, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/13/8d265594-06f1-478a-a5a3-e01b7897d340_20250513T18:45_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] calling from provider's office to check on the claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status stuff and do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have the policy number for that patient?
[CUSTOMER][NEUTRAL] Yes, it's 02456985 M as in Mary, L as in Lima number 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth [PII].
[AGENT][NEUTRAL] And what was the date of service and bill charges?
[CUSTOMER][NEUTRAL] Oh, sorry, what is that?
[AGENT][NEUTRAL] of service and bill charges.
[CUSTOMER][NEGATIVE] Uh yeah, data service for [PII] and the bill charges are $1,245 even.
[AGENT][NEUTRAL] And you said for 1,245?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, it looks like we received a claim on [PII].
[AGENT][NEUTRAL] Process 35 [PII].
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Benefits are only payable if major medical insurance provides benefits.
[AGENT][NEUTRAL] If claim is later considered, please provide explanation of benefits showing claims were paid.
[CUSTOMER][NEUTRAL] So we already submitted the primary insurance CUB via fax and it was sent on.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um, yes, it looks like, let me pull it up, looks like it was a duplicate, didn't contain any new information. Let me pull it up though.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, it looks like it received the.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yeah, I'm checking.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah, you we received the exact same explanation of benefits, didn't show anything allowed or anything applied to deductible.
[AGENT][NEGATIVE] So therefore, it can't process anything unless it shows that.
[CUSTOMER][NEUTRAL] So you're saying that you will be which you have received the, uh, that does not show the patient responsibility.
[AGENT][NEUTRAL] Yeah, it does, it doesn't show what was allowed and yes, that's correct. It doesn't show patient responsibility doesn't show what was allowed or anything applied towards the deductibles.
[CUSTOMER][NEUTRAL] OK, just give me a moment.
[CUSTOMER][NEUTRAL] Uh, if you can check the UOB, it is showing that uh there is a patient responsibility.
[CUSTOMER][NEUTRAL] Of $318.89.
[AGENT][NEUTRAL] It says non-covered charges.
[AGENT][NEUTRAL] 31889, tied or non-covered charges.
[AGENT][NEUTRAL] Show a patient responsibility.
[AGENT][NEGATIVE] It was denied.
[CUSTOMER][NEUTRAL] OK, just let me check one more time.
[CUSTOMER][NEUTRAL] OK. Uh, yeah, I will check with the primary insurance uh one more time and uh.
[CUSTOMER][NEUTRAL] I'll give you a call back. What is the call reference number?
[AGENT][NEUTRAL] My name is [PII] and today's date.
[CUSTOMER][NEUTRAL] So that will be all for now.
[AGENT][POSITIVE] Thanks for calling APL. Hope you have a good day.