AccountId: 011433970860
ContactId: a8091bd4-2da9-442c-96c6-ccbf113ebbcf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 347179 ms
Total Talk Time (AGENT): 92943 ms
Total Talk Time (CUSTOMER): 150150 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/a8091bd4-2da9-442c-96c6-ccbf113ebbcf_20250327T17:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from [PII] office. This call is regarding the check claim status.
[AGENT][POSITIVE] OK, I'm happy to check on a claim for you today. Can I get the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, patient policy number is
[CUSTOMER][NEUTRAL] 0255
[CUSTOMER][NEUTRAL] 596 7.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] yeah.
[AGENT][NEUTRAL] And can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Patient name is [PII].
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] All right, and date of service?
[CUSTOMER][NEUTRAL] Date of service is [PII].
[CUSTOMER][NEUTRAL] $1,815.
[AGENT][NEUTRAL] In the build amount.
[AGENT][POSITIVE] Thank you. And do you have a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Hey, I'm not showing any claims on file for that date of service and build amount.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, uh, data service is in range.
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] Yes, thank you again. I've searched [PII]. I don't show a claim on file for the billed amount of $1,815.
[CUSTOMER][NEUTRAL] Uh, I have a claim number. Can I provide the claim number?
[AGENT][NEUTRAL] What's that?
[CUSTOMER][NEUTRAL] Yeah, claim number. I have CIN number. Claim number is 1572694.
[AGENT][NEUTRAL] You said 1542694?
[CUSTOMER][NEGATIVE] No, no.
[CUSTOMER][NEUTRAL] No, 3572694.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] 75
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] 93736.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] I love.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] OK, this claim is showing that it was denied because it's saying that it was previously paid.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. 0129.95 processing info in correct.
[AGENT][NEGATIVE] Correct, it was denied because it was already paid.
[CUSTOMER][NEUTRAL] Primary insurance already paid the maximum amount, correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] Uh, the denial reason is showing it was already paid. That's the denial.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, so the claim was denied because the maximum benefits for this date have already been paid.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, I, I have a 29 claim for same patient for the same scenario.
[AGENT][NEUTRAL] You need to check another date of service?
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] What's the bill amount?
[CUSTOMER][NEUTRAL] $298.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] OK, this claim was received and denied. The maximum benefits for the state of service had already been met.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Could you provide the uh
[CUSTOMER][NEUTRAL] Claim num uh sorry, could you provide the contact number?
[AGENT][NEUTRAL] Call references my name with my last initials and today's date. My name is [PII], that's [PII] Last initial is [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else? Yeah.
[CUSTOMER][NEUTRAL] And today's date.
[CUSTOMER][NEUTRAL] No, thank you. Yeah.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Mhm. Bye-bye.