AccountId: 011433970860
ContactId: 8d5b9ead-dbdb-4570-b754-38e80f956e41
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 244570 ms
Total Talk Time (AGENT): 71143 ms
Total Talk Time (CUSTOMER): 57548 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/8d5b9ead-dbdb-4570-b754-38e80f956e41_20250516T20:08_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, hi. My name is [PII] and I'm calling from the provider's office for a medical claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Yeah, patient name and uh or the policy number of the patient.
[CUSTOMER][NEUTRAL] It's 024.
[CUSTOMER][NEUTRAL] 44783.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] State of service and bill charges.
[CUSTOMER][NEUTRAL] Data services 23-2025.
[CUSTOMER][NEUTRAL] And the bill charge is $21,487 even.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] OK, it looks like we received the claim on, let me make sure this isn't it.
[AGENT][NEUTRAL] Receive the claim [PII].
[AGENT][NEUTRAL] Process [PII].
[AGENT][NEUTRAL] Uh, it looks like we need an explanation of benefits that lists specifically the amounts applied to the deductible, co-pay, and or co-insurance.
[CUSTOMER][NEUTRAL] OK. So it is denied for explanation of benefits, right?
[AGENT][NEUTRAL] So, we received the explanation of benefits, but it did not list how it applied to deductible, co-pay or co-insurance. So we need an EOB that shows that.
[CUSTOMER][NEUTRAL] So, you need the primary UV?
[AGENT][POSITIVE] Yes, with a detailed listing.
[CUSTOMER][NEUTRAL] OK, one second. Uh, is there any information about primary insurance?
[AGENT][NEUTRAL] Uh, is it
[AGENT][NEUTRAL] Yeah, we, we received the primary explanation of benefits from you, but it doesn't list how the amounts were applied to deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] OK, we should, uh, send, send back, uh, primary way with, uh, correct, right?
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And what is the time defining limit?
[AGENT][NEGATIVE] Uh, there's no timely filing limit.
[CUSTOMER][NEUTRAL] OK. And uh uh can I get the fax number or mailing address to send the primary of it?
[AGENT][NEUTRAL] Fax number is [PII].
[CUSTOMER][NEUTRAL] Got it. And can I get the call reference?
[AGENT][NEUTRAL] That's my name, [PII]. First initial to last name [PII], and today's date.
[CUSTOMER][POSITIVE] Got it. Thank you so much for that and have a nice day.
[AGENT][POSITIVE] Thank you for calling APL. You as well. Goodbye.