AccountId: 011433970860
ContactId: b76e99d0-738c-456f-be5e-82a0e8c38638
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 553739 ms
Total Talk Time (AGENT): 179710 ms
Total Talk Time (CUSTOMER): 201577 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/b76e99d0-738c-456f-be5e-82a0e8c38638_20250121T15:18_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from Norton Hospital to check on a claim status.
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number?
[CUSTOMER][NEUTRAL] Yeah, sure. The callback number is [PII].
[AGENT][NEUTRAL] OK, thank you [PII], do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, I have a policy number. The policy number is 2502544684. The member name is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I yeah.
[AGENT][NEUTRAL] OK, and [PII], can you confirm the insured's date of birth for me?
[CUSTOMER][NEUTRAL] Yeah. It's [PII].
[AGENT][NEUTRAL] OK, thank you, and you said you're calling to check claim status, is that correct, [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I could definitely take a look. What's that data service and build them out?
[CUSTOMER][NEUTRAL] The date of services on [PII] for the amount of $1,101 even.
[AGENT][NEUTRAL] You said $1,101?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I can definitely take a look, uh, give me just a second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And your name is [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK. And your first name, [PII]?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] [PII] and that's actually gonna be the call reference number so it'd be my name with the first initial to my last name and the date, the date, the date today sorry I can't talk today for some reason.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Thank you so much, [PII].
[AGENT][NEUTRAL] You're welcome. I have a claim number whenever you're ready.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's 354.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 7780.
[CUSTOMER][NEUTRAL] 85
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The claim was
[CUSTOMER][NEUTRAL] 7780.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] The claim was received [PII] processed.
[AGENT][NEUTRAL] Um, so the claim was received actually before [PII]. It just the reported date did change whenever the claim was um processed due to the premium.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So
[AGENT][POSITIVE] The claim was actually pro uh.
[AGENT][NEUTRAL] Received on [PII], but it was processed on [PII].
[CUSTOMER][NEUTRAL] OK, it's, uh, received on [PII] and processed on [PII], right?
[AGENT][NEUTRAL] 12, uh-huh.
[AGENT][NEUTRAL] So the claim did deny.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Um, give me just a second here.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] Um, the claim did deny stating that the medical test for the state of service is a non-covered diagnostic test. Therefore, no benefits are payable for this claim.
[CUSTOMER][NEUTRAL] Not covered us. Can you reset it, uh.
[CUSTOMER][NEUTRAL] Not covered by the eligibility, right?
[AGENT][NEUTRAL] Yes, it's a non-covered diagnostic test.
[AGENT][NEUTRAL] For the policy.
[CUSTOMER][NEUTRAL] Not covered diagnosis.
[CUSTOMER][NEUTRAL] What the
[CUSTOMER][NEUTRAL] Policy, OK.
[CUSTOMER][NEUTRAL] And uh one moment.
[CUSTOMER][NEUTRAL] And uh can you verify with which diagnosis code is not covered?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Um, let's see here.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Mm let me pull the claim.
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEGATIVE] Actually, [PII], one moment. Actually, we received a UB and got a denial like uh PR 227. It's like information requested from the patient insured not provided incomplete.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so at first the insured was noncovered because the premium hasn't been received and then the premium was received so we went back and reprocessed the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the claim that was received, it was an ultrasound?
[AGENT][NEUTRAL] And an ultrasound is noncovered under the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And uh may I know the diagnosis for which got denied?
[AGENT][NEUTRAL] 76536.
[CUSTOMER][NEUTRAL] 76536, right?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Because she actually, I received an UB on [PII]. After that, we don't receive any UOB. Can you send me the UB of the current one?
[AGENT][NEUTRAL] Uh, yeah, what's your fax number?
[CUSTOMER][NEUTRAL] Well
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] OK. Uh, uh, [PII], can I know the claim, uh, timelying for this?
[AGENT][NEUTRAL] There's not one.
[AGENT][NEUTRAL] But if there if there was, there's not a timely filing, but if there was in fact an ultrasound completed, then there's, there can't be a correct the claim submitted.
[CUSTOMER][NEUTRAL] Sorry?
[CUSTOMER][NEUTRAL] Oh, OK. So there is no timely filing for this, right?
[AGENT][NEUTRAL] Uh, no, sir.
[CUSTOMER][NEUTRAL] OK. May I know the mailing address?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Can you spell it?
[AGENT][NEUTRAL] OK, [PII]
[CUSTOMER][NEUTRAL] OK, [PII]
[AGENT][NEUTRAL] No, it's OK [PII]
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] City
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh. Yes, sir.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] The state is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] It's OK, is the abbreviation.
[CUSTOMER][NEUTRAL] OK, is the abbreviation. OK, is the abbreviation, right? OK, right.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][NEUTRAL] And the
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] 24. OK. And uh attention to?
[AGENT][NEUTRAL] Claims
[CUSTOMER][NEUTRAL] Cla
[CUSTOMER][NEUTRAL] And can you verify with the PR ID for this?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 801.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] She was as smart as I need.
[CUSTOMER][NEUTRAL] OK. [PII], can I have the call oh call reference number is your name and wait, right?
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][NEUTRAL] OK. One moment, I'll be checking whether I received all the information or not.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, no problem.
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. I am fine. I have received all the information.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well is there anything else I can help you with?
[CUSTOMER][POSITIVE] Thank you so much for your information. Have a great day for you.
[AGENT][POSITIVE] You too well thanks for calling APL.
[CUSTOMER][NEUTRAL] No, it's fine.
[CUSTOMER][NEUTRAL] Yeah bye bye.
[AGENT][NEUTRAL] Alright bye bye.