AccountId: 011433970860
ContactId: bc7e0ff1-86f9-4c73-a8cf-91938d07feda
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 365399 ms
Total Talk Time (AGENT): 109185 ms
Total Talk Time (CUSTOMER): 64874 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/bc7e0ff1-86f9-4c73-a8cf-91938d07feda_20250521T19:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Pleasant Dale Ambulatory Care regarding a claim.
[AGENT][NEUTRAL] OK, I can help you with the claim.
[AGENT][NEUTRAL] And uh Ms. [PII], what is your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then can I get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah, patient is [PII]. Date of birth [PII]. Policy number is 01306740.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 3
[AGENT][NEUTRAL] OK, and then what is the date of service of the claim?
[CUSTOMER][POSITIVE] Bless you
[CUSTOMER][NEUTRAL] Data service is.
[CUSTOMER][NEUTRAL] [PII] for $5500.
[AGENT][NEUTRAL] OK, and then what are the charges after the primary insurance paid their part?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So that would be 63874.
[AGENT][NEUTRAL] OK, thank you, and I'm gonna put you on a quick hold, Miss [PII], while I pull up this claim for us and I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 357.
[AGENT][NEUTRAL] 5641.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, Ms. [PII]. I've got the claim pulled up for you now.
[AGENT][NEUTRAL] The claim number is 357.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 5641.
[AGENT][NEUTRAL] And the claim was denied because the insured's primary insurance provided full benefits. There are no benefits payable.
[CUSTOMER][NEUTRAL] OK, so you don't cover the deductible?
[AGENT][NEUTRAL] No, it says that the insurance, the primary insurance provided full benefits, so there are no benefits payable.
[CUSTOMER][NEUTRAL] OK, but there's a deductible applied. So do you cover the deductible?
[AGENT][NEUTRAL] The um policy does help with deductible co-pay or co-insurance, but based on the explanation of benefits from the primary insurance, they provided full benefits, so there were no benefits payable.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, but um it wasn't in full because they did apply deductibles. So do you not pick up the deductible?
[AGENT][NEUTRAL] Uh, I can, um,
[AGENT][NEGATIVE] Ask you to resend the claim if you wanted to resend the claim, but right now based on the information that we got, there were no benefits payable.
[CUSTOMER][NEUTRAL] OK, so patients responsible for the balance?
[AGENT][NEUTRAL] We do not give patient responsibility. We allow the provider to do that.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] She would be responsible for the bounce then. um, and can I just have your name and a reference number?
[AGENT][POSITIVE] Absolutely you can use um my name [PII] and today's date for your reference.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you for your help.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. I hope you have a wonderful rest of your week and thanks for calling APL.
[CUSTOMER][POSITIVE] Thanks you too bye.
[AGENT][NEUTRAL] Bye bye ma'am.