AccountId: 011433970860
ContactId: 9289e118-d37f-4055-b144-0c739fcebea6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 232729 ms
Total Talk Time (AGENT): 72053 ms
Total Talk Time (CUSTOMER): 85587 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=2.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/9289e118-d37f-4055-b144-0c739fcebea6_20250522T19:45_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name's [PII]. I'm calling from Primary Medical physicians, and I needed to check on a claim for one of your members.
[AGENT][NEUTRAL] OK, I can help you with the claim, Ms. [PII]. Um, may I please get your callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK, thank you. And what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII], and the policy number is 01682909M as in Mary, L as in Larry, number 8.
[AGENT][POSITIVE] OK, thank you very much. Let me look him up real quick.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, I've got [PII] pulled up, and what is his data service?
[CUSTOMER][NEUTRAL] I have actually 1234 of them for him, um, the first one was 828 2024.
[CUSTOMER][NEUTRAL] Total amount billed was 239905.
[AGENT][NEUTRAL] OK, and then what was the amount after the primary paid?
[CUSTOMER][NEUTRAL] Um, $219.96.
[AGENT][NEUTRAL] OK, let me look him
[CUSTOMER][NEUTRAL] They didn't pay it, they put it towards the deductible.
[AGENT][NEUTRAL] OK, thank you. I'm gonna put you on a quick hold while I look up this claim and I will be right back.
[CUSTOMER][POSITIVE] OK, thanks.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you very much for holding for me, [PII]. I've got the claim pulled up. The claim number is 3579748.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] And the claim was denied because it's non-covered in a doctor's office or clinic.
[CUSTOMER][NEUTRAL] OK, so it's secondary doesn't pick up the deductibles from, from the primary insurance? It's not for that?
[AGENT][NEUTRAL] Well, I'm the patient's plan, office visits are not covered.
[CUSTOMER][NEUTRAL] OK, so anything that has office visit is gonna just be what, OK, because he has several of them, so, and he told me to file in I I guess he thought that it was gonna be covered.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Um, let me see if I have any without doctors visits, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, they're, I think they're all, yeah, they're all office visits. All right, I'll let the patient know. Thank you so much.
[AGENT][NEUTRAL] OK. OK.
[AGENT][POSITIVE] Well, you're very welcome, Ms. [PII]. Is that everything I can help you with before we go?
[CUSTOMER][POSITIVE] That's it. Yup, that's it. Thank you so much.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome you have a good Memorial Day weekend and thank you for calling APL.
[CUSTOMER][POSITIVE] Thanks.
[AGENT][NEUTRAL] Bye-bye, ma'am.
[CUSTOMER][POSITIVE] Thanks bye bye.