AccountId: 011433970860
ContactId: aaca5241-55f9-4ff9-92ba-cf91b3263eeb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 363480 ms
Total Talk Time (AGENT): 135452 ms
Total Talk Time (CUSTOMER): 114002 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/aaca5241-55f9-4ff9-92ba-cf91b3263eeb_20250131T13:35_UTC.wav
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[AGENT][NEUTRAL] APL. This is [PII]. How you?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from our office to check up on the claim status.
[AGENT][NEUTRAL] I can assist you. Can you spell your first name, please?
[CUSTOMER][NEUTRAL] Yes, my name is spelled [PII].
[AGENT][NEUTRAL] [PII]? OK. What's the policy number, [PII]?
[CUSTOMER][NEUTRAL] The policy number is
[CUSTOMER][NEUTRAL] 02536197.
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, my callback number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Patient name is uh [PII].
[AGENT][NEUTRAL] The date of birth?
[CUSTOMER][NEUTRAL] Yes, the date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, spell the first name for me of the patient.
[CUSTOMER][NEUTRAL] Yes, that is [PII].
[AGENT][NEUTRAL] Thank you [PII] and you said you're checking for a claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And for what date of service?
[CUSTOMER][NEUTRAL] The first is [PII].
[AGENT][NEUTRAL] Are you a medical provider or dental provider's office?
[CUSTOMER][NEUTRAL] Uh, medical provider office.
[AGENT][NEUTRAL] OK, so the policy number for the medical policy is 253.
[AGENT][NEUTRAL] 62667.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] No, the medical policy number is
[CUSTOMER][NEUTRAL] 02536197.
[AGENT][NEUTRAL] That's for the dental policy. The policy number for the medical plan is 2253.
[CUSTOMER][NEUTRAL] One moment, let me check this.
[AGENT][NEUTRAL] 62.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 67. That's the correct number.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] And you said that the date of service is [PII]?
[CUSTOMER][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] And give me the bill amount again, please.
[CUSTOMER][NEUTRAL] The amount is $1870 even.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I'm showing the claim was received [PII].
[AGENT][NEUTRAL] Processed [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 24.
[AGENT][NEUTRAL] There was no payment made on this claim, uh, because the benefit maximum.
[AGENT][NEUTRAL] For this date of service has been met.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, actually, uh, yes, uh, we have, we have checked our billing summary. We have built, uh, this one claim only for the date of service.
[AGENT][NEUTRAL] Sorry, I didn't understand.
[CUSTOMER][NEUTRAL] Uh, we have checked our billing summary. Uh, we don't find any other claim.
[CUSTOMER][NEUTRAL] After this.
[CUSTOMER][NEUTRAL] We have billed only one claim for the date of service.
[AGENT][NEUTRAL] OK, we did receive the claim.
[AGENT][NEUTRAL] The claim was denied because the maximum benefit is met.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I have the claim number. Let me know when you're ready.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes, I'm ready.
[AGENT][NEUTRAL] That claim number is 253-553.
[AGENT][NEUTRAL] 72
[AGENT][NEUTRAL] 17
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, the explanation of benefits was mailed to the address on your claim on [PII] and can now be downloaded from our website, which is secured. [PII].
[CUSTOMER][NEUTRAL] OK, got it. Uh, could you please spell your name for documentation purpose?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, uh, OK, could you please send the claim back for a review because we bill the only one claim for the data service.
[AGENT][NEUTRAL] Right. And so the claim that you submitted was denied.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, can you send me the medical records for this claim?
[AGENT][NEUTRAL] Can you submit a medical appeal?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, you can.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, may I know the mailing address?
[AGENT][NEUTRAL] It's the same as the claims mailing address [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] How.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII], can I get a call reference number for this plan?
[AGENT][NEUTRAL] My name in today's date.
[CUSTOMER][POSITIVE] Got it. Thank you. Thank you for help today, [PII]. Have a nice day and stay safe.
[AGENT][POSITIVE] You're welcome [PII], thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Mhm.