AccountId: 011433970860
ContactId: f3d4d38a-2c2b-4539-9548-d290b6afbf41
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 361500 ms
Total Talk Time (AGENT): 86206 ms
Total Talk Time (CUSTOMER): 123325 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/f3d4d38a-2c2b-4539-9548-d290b6afbf41_20250514T14:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] For calling ATL, this is [PII].
[CUSTOMER][NEUTRAL] Yeah, hi, ma'am. This is [PII] calling you from provider's office to chicken and cream status.
[AGENT][NEUTRAL] OK, I can help you with claim status and I missed your name. What was that?
[CUSTOMER][NEUTRAL] Is your name
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] Sure, OK.
[AGENT][NEUTRAL] And do you have the policy number for the patient?
[CUSTOMER][NEUTRAL] Yes, I do have that. That's gonna be, should I start, ma'am, if you're ready?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, that's 02456985, M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] And you have a good callback number, [PII]?
[CUSTOMER][NEUTRAL] Sure, that's gonna be.
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Do you have the patient name and date of birth?
[CUSTOMER][NEUTRAL] Yes, ma'am. The patient name is gonna be [PII] and date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what was that date of service and bill charges?
[CUSTOMER][NEUTRAL] Yes, ma'am. The date of service is gonna be.
[CUSTOMER][NEUTRAL] [PII] and the bill amount is $1,245 and even.
[AGENT][NEUTRAL] It looks like the uh claim was received [PII].
[CUSTOMER][NEUTRAL] I think the uh claim was received [PII].
[AGENT][NEUTRAL] Also 35 [PII].
[CUSTOMER][NEUTRAL] 3
[AGENT][NEUTRAL] Benefits are only payable if major medical insurance provides benefits.
[CUSTOMER][NEUTRAL] Mhm. Benefits are only payable if major medical insurance provides.
[AGENT][POSITIVE] It was later paid by major medical pleased an explanation of benefits showing it was paid.
[CUSTOMER][NEUTRAL] Letter
[CUSTOMER][NEUTRAL] OK, you received the UB, right? And it was paid?
[AGENT][NEUTRAL] Let me pull it up.
[CUSTOMER][NEUTRAL] Hello, ma'am, are you there?
[AGENT][NEUTRAL] Yeah, I'm looking.
[AGENT][NEUTRAL] I just submitted a it the EOB was submitted. It shows billed amount. There's no allowed amount or deductible amount or patient responsibility amount. That's what we're, we have to have.
[CUSTOMER][NEUTRAL] DO
[CUSTOMER][NEUTRAL] we
[CUSTOMER][NEUTRAL] OK, initially, OK, the original name is [PII] for primary yoga, right, ma'am?
[AGENT][NEUTRAL] We have the primary EOB, but it doesn't show what the patient responsibility is, how it was applied, if it was applied to the deductible. We have to have that showing and that's not, we didn't submit that.
[CUSTOMER][NEUTRAL] So what the patient
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let me check, ma'am. Just allow me a minute.
[CUSTOMER][NEUTRAL] OK. Actually, ma'am, the, like Medicare is designed for.
[CUSTOMER][NEGATIVE] They haven't applied to anything, ma'am. It was denied for.
[CUSTOMER][NEUTRAL] Non-covered charges, ma'am.
[AGENT][NEUTRAL] we won't process the claim unless the primary insurance um considers it.
[CUSTOMER][NEUTRAL] OK, let me check ma'am.
[CUSTOMER][NEUTRAL] Just allow me a minute, ma'am, and let me check.
[AGENT][NEUTRAL] Somebody called on this exact claim yesterday.
[AGENT][NEUTRAL] Explain the same thing.
[CUSTOMER][NEUTRAL] Ma'am, ma'am, OK, uh signal already applied towards deductable, ma'am. So can you check once again? It was applied towards deductable.
[AGENT][NEGATIVE] It does not show that on the explanation of that.
[CUSTOMER][NEUTRAL] And we send that to you.
[AGENT][NEGATIVE] It doesn't show that you'll need to submit something that shows that.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] the the.
[CUSTOMER][NEUTRAL] OK, ma'am. OK, can I, ma'am, can I have the fax number to send it again after I got the correctly OK.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and can, can I get the call reference number for our call?
[AGENT][NEUTRAL] My name is [PII], first initial [PII] name [PII], and today's date.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you, ma'am, for your great assistance. That's all for today. Bye-bye. Have a great day.
[AGENT][POSITIVE] Thanks for calling APLU as well bye bye.