AccountId: 011433970860
ContactId: 93c3f6ef-ae87-4301-898c-074bfff10296
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 269040 ms
Total Talk Time (AGENT): 92913 ms
Total Talk Time (CUSTOMER): 133667 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/93c3f6ef-ae87-4301-898c-074bfff10296_20250107T17:25_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] [PII] this is
[CUSTOMER][NEUTRAL] Hi, [PII]. Good afternoon. This side is [PII], spelled as [PII] Last name is [PII]. I'm calling you from the provider office. I'm checking.
[AGENT][NEGATIVE] OK, you're going a little too fast for me. Could you slow down and repeat yourself?
[CUSTOMER][NEUTRAL] Uh yeah, my name is [PII]. It spelled as [PII] Last name is [PII]. I'm calling you from the provider office. I'm checking claim status.
[AGENT][POSITIVE] Sure, yeah, and I can assist you with that. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] It is [PII]. It's a direct line. And the policy ID is uh
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh yeah. It is 02465004, M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you, could you verify the patient's name and date of birth, [PII], where you're calling to check the status of?
[CUSTOMER][NEUTRAL] Uh yeah. My name is [PII] and date of birth is [PII].
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And what is the date of service that you're inquiring claim status for?
[CUSTOMER][NEUTRAL] Uh, it is [PII], and the bill amount is $600 even.
[AGENT][NEUTRAL] There was no payment made on this claim because we're requesting the primary EOB to be sent in.
[CUSTOMER][NEUTRAL] Uh, when did you processed this claim?
[AGENT][NEUTRAL] The claim was received [PII]. It was processed [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it was uh denied as requesting a primary UB. So could you let me know which one is primary insurance?
[AGENT][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] I'm not sure who's their primary insurance company, but we're not the primary. We're Gap Insurance.
[CUSTOMER][NEUTRAL] Which one is premium insurance, please?
[CUSTOMER][NEUTRAL] OK. Can I get, uh, can I get the claim number, please?
[AGENT][NEUTRAL] Sure, the claim number is.
[AGENT][NEUTRAL] 354-585-6 that's 354585-6.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it. Well, I have one more claim. Could you please assist me for one more claim?
[AGENT][NEUTRAL] It's the same member or a different member?
[CUSTOMER][NEUTRAL] Uh, different member.
[CUSTOMER][NEUTRAL] And uh what's the call reference number for this one?
[AGENT][NEUTRAL] What is the policy number?
[AGENT][NEUTRAL] There's no reference number. You can use the claim number as a reference.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, the national member ID is it. One moment.
[CUSTOMER][NEUTRAL] Yeah, the next member ID is uh
[CUSTOMER][NEUTRAL] 01967127 M as in Mike [PII] as in [PII] number 7.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth that you're inquiring on claim status for?
[CUSTOMER][NEUTRAL] Uh yeah. My name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] And what is your date of service?
[CUSTOMER][NEUTRAL] Date of service is [PII] and the bill amount is $600 even.
[AGENT][POSITIVE] 3461. Thank you.
[AGENT][NEGATIVE] This claim was received [PII]. It was processed [PII]. There was no payment made on this claim.
[AGENT][NEUTRAL] And the reason why there was no payment is because the maximum benefits were paid for that date of service. The member has benefits per calendar day and the benefits were exhausted for the date of service.
[CUSTOMER][NEUTRAL] And claim is denied for what reason?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, maximum benefit made in terms of number of visit or number of dollar.
[AGENT][NEUTRAL] Number $1 per day.
[CUSTOMER][NEUTRAL] OK. How many dollars was allowed in a day?
[AGENT][NEUTRAL] $1000 per calendar day.
[CUSTOMER][NEUTRAL] $1000 per calendar day and patient to the last service on which date?
[AGENT][NEUTRAL] The same data service of your claim.
[CUSTOMER][NEUTRAL] Uh, [PII]. OK. Uh, thank you. Do you see any other insurance for this patient?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Uh, can I get the claim number, please?
[AGENT][NEUTRAL] The claim number is 352-34613523461.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you, sir. I'm done. I'm done with my claims. Thank you for your assistance.
[AGENT][POSITIVE] Thanks for calling APL and have a great day. Good bye.
[CUSTOMER][NEUTRAL] You too. Bye