AccountId: 011433970860
ContactId: b7ed5c54-dd56-4d71-aaa6-f2a2a83136ee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 298140 ms
Total Talk Time (AGENT): 116511 ms
Total Talk Time (CUSTOMER): 91735 ms
Interruptions: 0
Overall Sentiment: AGENT=2.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/b7ed5c54-dd56-4d71-aaa6-f2a2a83136ee_20241230T17:10_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm not sure I'm in the right department. I'm trying to check claims.
[AGENT][NEUTRAL] OK, I can assist. May I have your name please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], thank you, and your call back number if we are disconnected please.
[CUSTOMER][NEUTRAL] My direct line is [PII].
[AGENT][POSITIVE] Thank you so much. And what is the policy number, please?
[CUSTOMER][NEUTRAL] The policy number I have is.
[CUSTOMER][NEGATIVE] Crap.
[CUSTOMER][NEUTRAL] Where did you go? Oh, sorry, 2 seconds, hold on. OK. 1967922.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, one moment please, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let me just repeat that number to you to confirm. I have that as 1967922.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you. And verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], date birth is [PII].
[AGENT][POSITIVE] OK, I appreciate that verification of the member. I have her pulled up and again you're calling for claim status, um, as noted, I can assist you. Give me one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you can also check claim status by visiting our secure portal at [PII]. Um, what is the date of service and the total charges, please?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] So the charge is $115.
[AGENT][POSITIVE] OK, thank you so much, [PII]. One moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the procedure code or codes billed for this service?
[CUSTOMER][NEUTRAL] 73,140
[AGENT][POSITIVE] Thank you very much for that information. It narrows it down. I appreciate that. One moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] I'm so sorry, excuse me, I'm so sorry. Pardon me for that.
[CUSTOMER][NEUTRAL] Somebody is, I'm gonna give me 2 seconds, I'm put you on a brief hold, OK.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I didn't hear you, but somebody at my door. Hold on.
[CUSTOMER][NEUTRAL] Who? Oh.
[CUSTOMER][POSITIVE] It started working. Yeah, I, I don't know what it was. I think it was the power went out. Maybe it was a glitch, so it worked fine. I did it twice. Thank you. I, I didn't know how to close it out, so I'm sorry. OK, alrighty, have a good one.
[CUSTOMER][POSITIVE] I'm so sorry about that.
[AGENT][POSITIVE] Uh, no problem, no problem. OK. No problem about that. No problem. I understand.
[CUSTOMER][NEUTRAL] Ma'am.
[AGENT][NEUTRAL] Understand perfectly. OK, it shows that we received the claim 3 times, um, let's see, the first time it was denied as the maximum.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Outpatient benefit had been met, which were allowed worth 5 visits. So this was a sick visit, so and it was denied because it exceeded the number of visits allowed payable.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK. Benefit max, OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] I have a claim number.
[CUSTOMER][NEUTRAL] OK, so would that be, is it?
[CUSTOMER][POSITIVE] Yeah, I need that oh yes please claim number thank you.
[AGENT][NEUTRAL] OK, you're welcome. The claim number is, the initial claim number is 35032777.
[CUSTOMER][NEUTRAL] 35032777
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, so is that, does that mean that we can uh PR patients?
[AGENT][NEUTRAL] APL does not determine patient's responsibilities, so I cannot give that information to you. I can advise it for you. I'm so sorry.
[CUSTOMER][NEUTRAL] Is it
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's OK. That's OK. Not a problem. OK, and then what about the other dials? Did they all be back for the same thing?
[AGENT][NEUTRAL] Well, the first initial denial uh denied as such, however, the other two, submissions denied as duplicates.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK. And I think that's all I needed. Um, your name is [PII], was it?
[AGENT][NEUTRAL] Yes, my name is [PII]. Last initial is [PII]. You can use my name and today's date for the reference.
[CUSTOMER][POSITIVE] Perfect. OK. All right, thank you. I appreciate your help.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day. Take care. Bye bye.
[CUSTOMER][NEUTRAL] You too bye bye bye.