AccountId: 011433970860
ContactId: eb4977c8-aedc-4fd4-bcb6-cafd1ff5bf94
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 233690 ms
Total Talk Time (AGENT): 79359 ms
Total Talk Time (CUSTOMER): 61592 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/eb4977c8-aedc-4fd4-bcb6-cafd1ff5bf94_20250528T18:39_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi um I'm calling from a provider's office. I was calling to see if I could get an update on a claim.
[AGENT][NEUTRAL] Sure, I can verify claim status for you and your name is?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And Ms. [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] It's 02262371 M like Mary L like Lima 8.
[AGENT][NEUTRAL] Thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, that's [PII].
[AGENT][POSITIVE] OK, thank you uh give me a moment.
[AGENT][NEUTRAL] And verify that patient's name, date of birth.
[CUSTOMER][NEUTRAL] [PII] and it's [PII].
[AGENT][NEUTRAL] OK, thank you, ma'am. And what was the date of service and amount of the charge?
[CUSTOMER][NEUTRAL] The date of service was, oh, bear with me one moment I just had it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, the date of service was [PII]. The total bill amount was $3100.
[AGENT][NEUTRAL] OK, thank you. And do you have the balance after primary is processed the claim?
[CUSTOMER][NEUTRAL] Uh, still, uh, 3100.
[AGENT][NEUTRAL] OK, let me a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You said the date of service is [PII]?
[CUSTOMER][NEUTRAL] No, [PII].
[AGENT][POSITIVE] [PII]. OK, thank you.
[AGENT][NEUTRAL] Let's see and you're calling from again?
[CUSTOMER][NEUTRAL] Uh, ENT and allergy Associates of Florida.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Uh let's see.
[AGENT][NEUTRAL] Let's see, uh, show that claim processed as benefits payable only as primary pays.
[AGENT][NEUTRAL] And looks like for the explanation benefits received, it doesn't show they applied any amounts towards deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] They'll only pay if their primary pays.
[AGENT][NEUTRAL] Yes, ma'am. With this policy is secondary, we only pick up what primary applies towards deductible, co-pay, or co-insurance and per the EOB we received, it doesn't show that they are primary applied any amount towards those three.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so it's denied.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, thank you. Could I just get a reference number?
[AGENT][NEUTRAL] Uh, if you like, you may use my name in today's date.
[CUSTOMER][POSITIVE] OK, alright, perfect, thanks for your help.
[AGENT][POSITIVE] Alright, you're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.