AccountId: 011433970860
ContactId: 91f6ac41-0722-4759-8d49-0c03e17ec14f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 373059 ms
Total Talk Time (AGENT): 77327 ms
Total Talk Time (CUSTOMER): 94222 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/91f6ac41-0722-4759-8d49-0c03e17ec14f_20250527T14:13_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII]. I'm calling from um MUSC University Medical Associates.
[AGENT][NEUTRAL] I mean
[CUSTOMER][NEUTRAL] And I was calling to ask um check status of claim.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, I do. It's area code [PII] and it's a direct line.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Um, patient's policy number is 02521729.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Um date of birth is [PII].
[AGENT][NEUTRAL] And you have the date of service and bill charges?
[CUSTOMER][NEUTRAL] Yes, data service is [PII] with um total charge of $17,712.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEGATIVE] OK, give me just a moment. Systems running just a bit slow.
[CUSTOMER][POSITIVE] OK, that's right.
[CUSTOMER][NEUTRAL] Mine is today too. It must be the weather.
[AGENT][NEUTRAL] Well, I've got, I've got that date of service on file, but it's for a different build amount. Um, let's see.
[CUSTOMER][NEUTRAL] It looks like you're secondary for this patient and there would have been $16619.10 left over after the primary process. Is that maybe the amount?
[AGENT][NEUTRAL] Well, we have a claim for like 55,000, is that, do you know if that's the original bill charges or?
[CUSTOMER][NEUTRAL] Um, that may be the hospital charges. Um, this is just a physician's bill, so that wouldn't have been ours.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Suspicious, OK.
[AGENT][NEUTRAL] Let me double check uh another.
[CUSTOMER][NEUTRAL] Looks like it was resubmitted on [PII].
[CUSTOMER][NEUTRAL] Part of that decline wasn't on file.
[AGENT][NEUTRAL] OK, I see it. Hold on one moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like we received it 3:31, 2025, process 41 2025.
[AGENT][NEUTRAL] Let me pull up the denial.
[AGENT][NEUTRAL] OK, looks like we didn't receive the primary explanation of benefits. We have the claim. I don't, but that's all we received.
[AGENT][NEUTRAL] Can you fax
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] Um, I can fax it, yes, that'd be great.
[AGENT][NEUTRAL] Uh, fax number is 877.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] OK, and what is the claim number that it will be um going with?
[AGENT][NEUTRAL] Yeah, it would be if you'll reference claim number 3583485.
[CUSTOMER][NEUTRAL] I can do that, um, and is there a reference number for our call that I can check?
[AGENT][NEUTRAL] That's just my name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK perfect thank you so much for your help. I really appreciate it and I'll get that right over immediately.
[AGENT][POSITIVE] OK, thank you so much. Thank you for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thanks you too. Bye-bye.