AccountId: 011433970860
ContactId: afdbfe58-b9c2-4f67-afa5-78c9d1566eb6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 523058 ms
Total Talk Time (AGENT): 70001 ms
Total Talk Time (CUSTOMER): 202216 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/afdbfe58-b9c2-4f67-afa5-78c9d1566eb6_20250129T14:01_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is, my name is I'm [PII] calling from the care team. How are you?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][NEUTRAL] I'm doing good. I have an insured on the other line. Um, can I give you the policy number?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it's 142.
[CUSTOMER][NEUTRAL] 356 3.
[CUSTOMER][NEUTRAL] Uh, it's, it's for part two.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it's
[CUSTOMER][NEUTRAL] Um, the claim number 3508589 was the denial that asked for the diagnosis code and then that last claim there processed was the redo.
[AGENT][NEUTRAL] What's, you said 350?
[CUSTOMER][NEUTRAL] Mhm. 858-9.
[AGENT][NEUTRAL] Data service 18.
[CUSTOMER][NEUTRAL] Uh, and 111.
[AGENT][NEUTRAL] 111.
[CUSTOMER][NEUTRAL] So they sent in the diagnosis codes, we reprocessed and then
[CUSTOMER][NEUTRAL] His thing is, why wasn't he reimbursed for the
[CUSTOMER][NEUTRAL] Um, deductible. I went over everything with him. I explained the provider, I mean not the provider, primary insurance paid. I went through all the reasons, explained it about three different ways. He still does not understand why we did not pay or reimburse him for the deductible.
[CUSTOMER][NEUTRAL] And he wants to speak with someone else.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, hold on one moment, OK?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello, Mrs. [PII].
[CUSTOMER][POSITIVE] Yes. Thank you so much for holding. I have [PII] on the line and she'll be assisting you further, OK?
[CUSTOMER][POSITIVE] OK, thank you. You're welcome.
[AGENT][NEUTRAL] This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yes, good morning, [PII]. My name is [PII]. My wife, [PII], several months ago, um, had an MRI prescribed by her doctor. She went to Palm MRI for the procedure.
[CUSTOMER][NEUTRAL] Before the procedure they asked for a $300 deductible which she paid out the.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] I subsequently submitted that receipt and was told that I need uh to provide them with the explanation of benefits from admin. I did, uh, the claim was processed but not completed because they wanted to have the diagnostic code which was not.
[CUSTOMER][NEUTRAL] In the explanation of benefits I provided that information because Palm MRI is currently out of business and we went to the the holder of all the information and they were able to provide us with a diagnostic code which I uploaded a couple days ago. I am now being told that.
[CUSTOMER][NEUTRAL] My $300 is not reimbursable because the primary.
[CUSTOMER][NEGATIVE] Primary insurance paid the entire balance, but the entire balance did not include the payment issued by my wife. Why am I not being reimbursed for the payment issued by my wife?
[AGENT][NEUTRAL] OK, what date of service was it for?
[CUSTOMER][NEUTRAL] [PII], I, I cannot remember that much detail out of my head. I'll have to log on to the system to get it, but it was in, uh, mid June.
[AGENT][NEUTRAL] Was it for this year or I mean, um.
[CUSTOMER][NEUTRAL] Last it was it was for last year.
[AGENT][NEUTRAL] Last
[AGENT][NEUTRAL] Last January, maybe?
[CUSTOMER][NEUTRAL] Last year.
[CUSTOMER][NEGATIVE] Yes, somewhere around there it may have been, it's been an extremely long time. She's just been bugging the heck out of me to see what's happening with this.
[AGENT][NEUTRAL] Hold on just a moment. Do you know how much the total bill was for that?
[CUSTOMER][NEUTRAL] I do not know what the total bill was. I just know what she had to come out of her pocket for, and that was $300.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] She did she have an MRI or a CT scan? Now, I see a CT scan.
[CUSTOMER][NEUTRAL] I'm going by the name of the business to MRI. It could have been a CT scan. I'm not sure.
[AGENT][NEUTRAL] OK, hold on, let me see who did this.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull the claim up. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 18
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Hold on just a moment. I'm trying to look at all the claims that come in for that.
[CUSTOMER][POSITIVE] OK, no worries.
[AGENT][NEUTRAL] Instead of you waiting, can I give you a call back after I review it and OK, that way you won't have to hold on the line. What's your phone number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK. I'll call you back in just a few minutes, OK?
[CUSTOMER][POSITIVE] Thank you so very much.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL. You have a good day and I'll call you back in a few minutes.
[CUSTOMER][POSITIVE] Good bye.
[CUSTOMER][POSITIVE] OK thank you bye.
[AGENT][NEUTRAL] Bye bye.