AccountId: 011433970860
ContactId: a380534a-58cb-4c82-999c-12776b9c9405
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 496269 ms
Total Talk Time (AGENT): 200929 ms
Total Talk Time (CUSTOMER): 223554 ms
Interruptions: 7
Overall Sentiment: AGENT=1.1, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/a380534a-58cb-4c82-999c-12776b9c9405_20250325T15:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, uh, this is [PII] calling from Hometown Urgent Care to check on the claim status. Uh, how are you doing today?
[AGENT][POSITIVE] I am doing good today, [PII]. How are you doing today?
[CUSTOMER][POSITIVE] I'm doing good as well. Thank you for asking. Uh, could you please help me with the claim status?
[AGENT][NEUTRAL] I can. What is your callback number, please?
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] Yes, sir. The callback number is [PII].
[AGENT][NEUTRAL] Thank you. What is the policy number, please?
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] Yes, sir. The policy number is 01922.
[CUSTOMER][NEUTRAL] 898.
[AGENT][NEUTRAL] OK, let me just repeat that to you, [PII], just to confirm I have that as 01922898.
[CUSTOMER][POSITIVE] Yes, sir. That's correct.
[AGENT][NEUTRAL] Thank you, and verify the patient's name and date of birth.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It's uh uh the first name is uh [PII], [PII]
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] And what is the last name?
[CUSTOMER][NEUTRAL] Oh my
[CUSTOMER][NEUTRAL] It's uh
[CUSTOMER][NEUTRAL] It's uh [PII] It's Miro Motors.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you very much for that information. I have it pulled up and again, you're calling for claim status so I can assist you, [PII]. What is the date of service and the total charge amount please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, sir. The date of service is [PII] and the bill amount is $672.55.
[AGENT][POSITIVE] OK, I'm so sorry, can you repeat that for me, please?
[CUSTOMER][NEUTRAL] Yes, I'm very sorry for that. It's uh uh [PII] and the bill amount is $672 542 cents.
[AGENT][NEUTRAL] OK, so that's $672.02.
[CUSTOMER][NEUTRAL] $2
[CUSTOMER][NEUTRAL] 52 cents, 52 cents.
[AGENT][NEUTRAL] 52. Thank you so much. Now with this particular policy, [PII], I did not show the claim on file. This policy has termed, Give me one moment to check for a policy within that.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] Service date OK?
[CUSTOMER][NEUTRAL] what
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And also you are able to check claim status by visiting our secure portal at [PII] and on that website you'll be able to obtain an EOB if you need one. Give me one second. I believe I may have had.
[CUSTOMER][NEUTRAL] to
[CUSTOMER][POSITIVE] Secured.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The look of finding a policy within that service. Give me one second please.
[CUSTOMER][POSITIVE] Give me one second please. Yes please.
[AGENT][NEUTRAL] 672 52.
[AGENT][POSITIVE] OK, one moment, I'm almost there, thank you very much for your patience.
[CUSTOMER][POSITIVE] They are thank you very much.
[AGENT][NEUTRAL] OK, thank you again. It shows that we received the claim and there was no payment on this particular claim. Let me give you the reasons why it denied. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] there was no
[CUSTOMER][NEUTRAL] Particular point and.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It shows that the
[AGENT][NEUTRAL] Premier insurance provided full benefits, so therefore no payments were made on this particular claim.
[CUSTOMER][NEUTRAL] Uh, you're saying the primary pain magazine, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Oh, what is the loan amount for this?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Um, may I know what is the received date and the denied date, please?
[AGENT][NEUTRAL] Of course one moment.
[CUSTOMER][NEUTRAL] Of course
[AGENT][NEUTRAL] The claim was received on [PII] and processed and denied on [PII].
[CUSTOMER][NEUTRAL] The coin was received
[CUSTOMER][NEUTRAL] Of 202
[CUSTOMER][NEUTRAL] 2025.
[CUSTOMER][NEUTRAL] OK. May I, uh, may I get the claim number, please?
[AGENT][NEUTRAL] Certainly it is 354-711-8.
[CUSTOMER][NEUTRAL] 354-711.
[CUSTOMER][NEUTRAL] One second, uh, 354-7118, right?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][POSITIVE] That's correct, yes, so.
[CUSTOMER][NEUTRAL] Uh, could you please, uh, fax the COB?
[AGENT][NEUTRAL] Um, you're able to obtain EBs on that website at [PII]. Um, what is your fax number?
[CUSTOMER][NEUTRAL] Not
[CUSTOMER][NEUTRAL] Yes, uh, uh, the fax number is [PII].
[CUSTOMER][NEUTRAL] 75
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I have that as [PII] for that fax number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, is there anything else I can assist you with, [PII]?
[CUSTOMER][NEUTRAL] Uh, one second now, before that, uh, uh, I'm sorry, the, you told, what is the loan amount for this?
[AGENT][NEUTRAL] Well, the major medical made full payment, so there is no payment on this.
[CUSTOMER][NEUTRAL] So they're
[CUSTOMER][NEUTRAL] OK, OK, got it.
[CUSTOMER][NEGATIVE] I was denied for primary paid maximum.
[CUSTOMER][NEUTRAL] OK. Uh, could you please, uh, help me with other claim for the same patient for different date of service?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, sir. The next date of service is [PII] and the uh bill amount is $597.52.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment, and that was just [PII]. OK, one moment, sir.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, this claim was received and denied as services rendered after the policy term.
[CUSTOMER][NEUTRAL] OK, uh, policies is inactive, right?
[AGENT][NEUTRAL] Correct. Pa active as of [PII].
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And there's no active policy for the member with APL?
[CUSTOMER][NEUTRAL] And um.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, may I know what is the, uh, received or denied date, please?
[AGENT][NEUTRAL] The claim was received on.
[AGENT][NEUTRAL] [PII] and processed and denied [PII].
[CUSTOMER][NEUTRAL] Process and
[CUSTOMER][NEUTRAL] Uh, may I get the claim number, please?
[AGENT][NEUTRAL] 356-483-8.
[CUSTOMER][NEUTRAL] Uh, could you please fax this COB2?
[AGENT][NEUTRAL] Yes, again, you're able to receive ELBs on that website at [PII], but I faxed this one over for you. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] Yes, I got it you're able to receive it.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, uh, no, I got all the required uh claims. If you don't mind, could you please spell your name?
[AGENT][NEUTRAL] Of course, my name is spelled [PII], last initials [PII].
[CUSTOMER][NEUTRAL] Spelled [PII]
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] And [PII], we do not provide reference numbers, but you can use my name in today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, [PII]. Uh thank you, thank you for your uh valuable time and assistance. I got all the required claims from you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Yes, thank you, bye.
[AGENT][POSITIVE] Mhm thank you.
[AGENT][POSITIVE] You have a great day, sir. Thanks for calling APL bye bye.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Yes. Bye. Take care.