AccountId: 011433970860
ContactId: e7eccf97-2f3e-454e-a844-f80c0f408b90
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 422399 ms
Total Talk Time (AGENT): 128936 ms
Total Talk Time (CUSTOMER): 194827 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/e7eccf97-2f3e-454e-a844-f80c0f408b90_20250619T15:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]?
[AGENT][NEUTRAL] Um, my name is [PII]. Um, yeah. Your name is [PII].
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][POSITIVE] Oh hi [PII] I'm sorry.
[CUSTOMER][NEUTRAL] Um, yeah, that's OK then it was, it was cutting out. That's why I was asking. OK, how you doing, [PII]?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][NEUTRAL] I'm doing all right. Um, I'm hoping you can help me. I'm calling from Triad radiology in [PII] and um I have a patient with a couple claims that um I don't have a response on, OK? and I was just checking to see what the status is on those claims.
[AGENT][NEUTRAL] Um, yes, ma'am. I can assist you with claim status. Um, first, could I get your name and a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] Absolutely. My name is [PII] Phone number is [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] Sure, um, policy number is 02580937.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Sure, this is [PII] Last name is [PII] Date of birth is [PII].
[AGENT][NEUTRAL] OK, and the date of service and bill charges on the first claim, please?
[CUSTOMER][NEUTRAL] Data service is, uh, it's, it's all um [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said the date of service was [PII]?
[CUSTOMER][NEGATIVE] [PII] I'm sorry, [PII]. I'm sorry, my brain's not working today.
[AGENT][NEUTRAL] No problem. I understand it's Thursday, one more day.
[CUSTOMER][NEUTRAL] I hear you.
[CUSTOMER][NEUTRAL] Um, so [PII] build amount $240 for an MRI and we do the reading, so we're not, we're not the facility, OK, the facility, um, bills separately, OK, we, you know, Forsy Medical Center would have built facility we're triad radiology, we're billing for the reading of that study.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and you said this was for date of service [PII] and the bill charges were $240?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, yes, ma'am. We did receive this claim. Um, the claim number is 3592861.
[AGENT][NEUTRAL] Let's see, we received it on [PII]. It processed on [PII], and this claim, um, actually, let's see, it denied because the benefit maximum for the calendar year was reached on a previous claim, and so that's why this claim denied.
[CUSTOMER][NEUTRAL] OK, alright, that's what I thought. Now, is there any kind of a discount or does the patient owe the whole balance?
[AGENT][NEUTRAL] The whole balance.
[CUSTOMER][NEUTRAL] OK, alright, um, OK, same data service if you would please Ey, um, build out $128.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, we received this one on [PII]. It processed on [PII]. The claim number is 3592868 and it's denying for the same reason the benefit maximum was reached on a previous claim.
[CUSTOMER][NEUTRAL] OK and OK and it's all on him, right?
[AGENT][POSITIVE] Yes, ma'am. That's correct.
[CUSTOMER][NEUTRAL] OK, alright, and then again same date of service, he had a second MRI for $222.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, received on [PII], processed on [PII]. This claim number is 3592865 and denied for the same reason benefit maximum was reached on a previous claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, I I hate billing people like this. Um, alright, then there was an X-ray. I'm, I'm hoping this one at least got paid, OK, an X-ray, same data service 114 2025 for $32.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is it as hot in [PII] as it is here?
[AGENT][NEUTRAL] Well, actually, I'm in [PII] and.
[AGENT][NEGATIVE] Yeah, it's burning up
[CUSTOMER][POSITIVE] Yeah, yeah, it's it's burning up here too in [PII]. It's like what I'm like, OK, like summer finally got here and wow, um.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK. Oh, yes, ma'am. And actually,
[CUSTOMER][NEUTRAL] So any payment on the X-ray?
[AGENT][NEGATIVE] No, ma'am. This one denied for the same reason, benefit maximum reach. Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, uh, is there a claim number on that one I can post to come?
[AGENT][NEUTRAL] Yeah, the claim number is 3592858.
[CUSTOMER][POSITIVE] 58 right. Ey, you've been very helpful. OK. I just wish you had better insurance. OK, um, I thank you so much for your help, very much so. OK. Now you have a, a wonderful day and you're, you're right, OK. One more day and we got the weekend, OK? So enjoy, stay inside, get to [PII]. OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] No problem.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] OK, I will, [PII]. You do the same and I thank you for calling APL.
[CUSTOMER][POSITIVE] You too have a great day bye bye.
[AGENT][POSITIVE] Mm, thank you. Bye.