AccountId: 011433970860
ContactId: ee24d127-d6af-4985-8113-49d12be4498a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 485709 ms
Total Talk Time (AGENT): 161485 ms
Total Talk Time (CUSTOMER): 259471 ms
Interruptions: 13
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/ee24d127-d6af-4985-8113-49d12be4498a_20250305T18:19_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from doctor's office to check claim status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status, Mr. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] OK, sure. I can assist you with the same status, Mr. [PII]. May I have a callback number just in case we get disconnected? Yeah, it's [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Thank you. And may I have the patient's policy number? Sure.
[CUSTOMER][NEUTRAL] It's 01991690. M as in Mary, L as in Lima, 8.
[AGENT][NEUTRAL] Thank you. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Thank you. What's the name and date of birth of the patient? Yeah, it's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And what's the date of service and the of the claims?
[CUSTOMER][NEUTRAL] Thank you. And what's the date of service and the of the claim? It's [PII].
[CUSTOMER][NEUTRAL] And the total charge is $11,2.09.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so that's [PII], the amount of $11,02.09.
[CUSTOMER][NEUTRAL] OK, so that's [PII], the amount of $11,02.09. Yes.
[CUSTOMER][NEUTRAL] This is
[AGENT][NEUTRAL] OK, Mr. [PII], for future, you can check claim status online through our website at [PII].
[CUSTOMER][NEUTRAL] OK, Mr. [PII], for future, you can check claim status online through our website at [PII].
[AGENT][NEUTRAL] And bear with me while I pull this ELB, OK?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And bear with me while I pull this EL be OK?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK. So it looks like we processed the claim on [PII].
[CUSTOMER][NEUTRAL] OK, it looks like we processed the claim on [PII].
[AGENT][NEUTRAL] And the claim was denied?
[CUSTOMER][NEUTRAL] [PII]. And the claim was denied.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The denial reason is that primary insurance provided full benefits.
[CUSTOMER][NEUTRAL] The denial reason is that primary insurance provided full benefits.
[CUSTOMER][NEUTRAL] You need for primary OB is it right?
[AGENT][NEUTRAL] No, the primary insurance based on the EOB, it looks like they pay the full amount.
[CUSTOMER][NEUTRAL] No, the primary insurance based on the EOB it looks like they pay the full amount.
[CUSTOMER][NEUTRAL] It means primary paid more than secondary, is it right?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] It means that they pay the full amount.
[CUSTOMER][NEUTRAL] What they said they pay the full amount.
[CUSTOMER][NEUTRAL] What is the exact reason, please?
[AGENT][NEUTRAL] That is the exact you know reason. Let me read it barbatum so you can put it down, OK.
[CUSTOMER][NEUTRAL] That is exactly our based so let me read a barbatumly so you can put it down, OK.
[AGENT][NEUTRAL] OK, so it's indicated.
[CUSTOMER][NEUTRAL] Can you please tell me OK, so it's indicated.
[AGENT][NEUTRAL] Insured.
[CUSTOMER][NEUTRAL] Insured
[AGENT][NEUTRAL] Primary
[CUSTOMER][NEUTRAL] Primary. OK.
[AGENT][NEUTRAL] Insurance
[CUSTOMER][NEUTRAL] Insurance
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Provided
[CUSTOMER][NEUTRAL] Provided
[AGENT][NEUTRAL] 4
[CUSTOMER][NEUTRAL] OK. 4.
[AGENT][NEUTRAL] Benefits
[CUSTOMER][NEUTRAL] Benefits
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] There are no.
[CUSTOMER][NEUTRAL] There are no
[AGENT][NEUTRAL] Benefits
[CUSTOMER][NEUTRAL] Benefits.
[AGENT][NEUTRAL] Payable.
[CUSTOMER][NEUTRAL] Payable.
[CUSTOMER][NEUTRAL] Provided to benefits, no unloan payable, is it right?
[AGENT][NEUTRAL] Um, can insure its primary insurance provided full benefits. There are no benefits payable.
[CUSTOMER][NEUTRAL] Um, we can insure its primary insurance provided full benefits. There are no benefits payable. OK. What's the meaning of dinner?
[AGENT][NEUTRAL] It means that there is nothing applied towards the deductible co-payment and co-insurance for us to pay.
[CUSTOMER][NEUTRAL] It means that there is nothing applied towards the deductible co-payment and co-insurance for us to pay.
[CUSTOMER][NEUTRAL] So that time what I do for the next action. If there is any need corrected claim or appeal.
[AGENT][NEUTRAL] If there is a corrected claim, you can send that corrected claim. If you need to submit an appeal, you have 180 days from the decision date to submit an appeal.
[CUSTOMER][NEUTRAL] If there is a corrected claim, you can send that corrected claim. If you need to submit an appeal, you have 180 days from the decision date to submit an appeal.
[CUSTOMER][NEUTRAL] OK. But uh what is the time you failing to submit a claim?
[AGENT][NEUTRAL] For correct the claims, we don't have timely filings.
[CUSTOMER][NEUTRAL] Or correct the claims, we don't have family filing.
[CUSTOMER][NEUTRAL] OK. What is the timely filing for the claim?
[CUSTOMER][NEUTRAL] And that
[AGENT][NEUTRAL] For regular claims, we don't have timely filing limits.
[CUSTOMER][NEUTRAL] A regular places, we don't have family final limits.
[CUSTOMER][NEUTRAL] OK. What is the contact and mailing address?
[AGENT][NEUTRAL] The address is [PII].
[CUSTOMER][NEUTRAL] The address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] [PII]. OK. Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is
[CUSTOMER][NEUTRAL] Can you please spell that? And the zip code is
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's [PII], is it right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][POSITIVE] Yes, that is correct. OK then.
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. What is the payer ID?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, for this one we need um.
[CUSTOMER][NEUTRAL] Um, for this one, we need, um,
[AGENT][NEUTRAL] The you from the primary insurance, so it needs to be either or.
[CUSTOMER][NEUTRAL] You and the primary insurance so we need to be in the now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, where is, what is the dinner date?
[AGENT][NEUTRAL] OK, uh, bear with me just a sec.
[CUSTOMER][NEUTRAL] OK, uh, bear with me just a second.
[AGENT][NEUTRAL] Denial date is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK is [PII].
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, what is the claim number?
[AGENT][NEUTRAL] OK, the claim number is 3568022.
[CUSTOMER][NEUTRAL] OK. The claim number is 3568022.
[CUSTOMER][NEUTRAL] OK, and what's the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers, you can use my name in today's date.
[CUSTOMER][NEUTRAL] We don't have a reference number, so you can use my name in today's date. Can you please spell your name?
[AGENT][NEUTRAL] Sure, that's [PII]. Last initial is [PII].
[CUSTOMER][NEUTRAL] Sure, that's [PII]. Last [PII] is [PII].
[CUSTOMER][NEUTRAL] It's so, is it right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][POSITIVE] Yes, that is correct.
[CUSTOMER][POSITIVE] Thank you sir for your kind assistance. Bye for now. Take care. Have a wonderful day.
[AGENT][POSITIVE] Yes sir, Mr. [PII], thank you for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Yes, Mr. [PII], thank you for calling APL. Bye-bye.