AccountId: 011433970860
ContactId: f0c4f6a6-8cc3-43c6-9f1f-fe2506b44d13
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 332380 ms
Total Talk Time (AGENT): 96548 ms
Total Talk Time (CUSTOMER): 161229 ms
Interruptions: 4
Overall Sentiment: AGENT=0, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/f0c4f6a6-8cc3-43c6-9f1f-fe2506b44d13_20250327T18:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from office. This call is regarding the check claim status.
[AGENT][NEUTRAL] Hey [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII]. Yes.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] 02555967.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth is [PII]. Yeah. Uh, this claim is denied, uh.
[AGENT][NEUTRAL] OK, thank you. And did you say claim status?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Member ID.
[AGENT][NEUTRAL] What was the date of service?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The bill amount?
[CUSTOMER][NEUTRAL] $123.
[AGENT][NEUTRAL] 123, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull that up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] working
[AGENT][NEUTRAL] OK, it looks like that claim was denied. Let me see what the reason was.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Could you please clarify the claim denied reason?
[AGENT][NEUTRAL] Uh, the maximum benefits for the confinement period have been paid.
[CUSTOMER][NEUTRAL] Previously paid. What did the paid amount previously?
[AGENT][NEUTRAL] Previously paid.
[AGENT][NEUTRAL] Um, I can only get status on what is paid for this particular claim or process. I can't discuss other payments on other claims.
[CUSTOMER][NEUTRAL] 17
[AGENT][NEUTRAL] It's just so they've they've already paid out for the inpatient confinement period and paid on a different claim.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is our primary insurance already paid, right?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] No, we already paid out for this benefit on a different claim.
[CUSTOMER][NEUTRAL] Yeah, I have another.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For a different provider.
[CUSTOMER][NEUTRAL] That's the primary, that is a primary paid more than secondary card?
[AGENT][NEUTRAL] Yeah, we consider what the primary paid, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have another, another one date of service for the same patient.
[AGENT][NEUTRAL] OK, um, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, what's that date?
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] And the bill charges?
[CUSTOMER][NEUTRAL] $234.
[CUSTOMER][NEUTRAL] I uh
[CUSTOMER][NEUTRAL] 234.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah I I.
[AGENT][NEGATIVE] Uh, that was denied for the same reason.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Maximum benefits have already been paid.
[CUSTOMER][NEGATIVE] Yeah, OK. OK. Uh, I have 25 claims for this, uh, patient for same denial reason.
[CUSTOMER][NEUTRAL] Can you provide the all date of service and charge amount?
[AGENT][NEUTRAL] For 25 claims?
[CUSTOMER][NEUTRAL] Yeah, 25 claim for same patient and same scenario.
[AGENT][NEUTRAL] OK, do you have access to our portal, our online portal?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] OK. Do you need the address, the the website address?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yes. Could you please provide
[AGENT][NEUTRAL] Yeah, it's secured. [PII].
[AGENT][NEGATIVE] There you can pull all EOBs immediately, which will give a denial reason.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, could you please, uh,
[CUSTOMER][NEUTRAL] Provide the call reference number and your name for documentation purpose.
[AGENT][NEUTRAL] Yes, my name is [PII] and and last initial is [PII], and today's date will be the reference number.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] OK, thank you for calling APL John, have a great afternoon.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Bye.