AccountId: 011433970860
ContactId: fafc4850-b7d8-4149-91b6-8d115ab76d54
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 340510 ms
Total Talk Time (AGENT): 103269 ms
Total Talk Time (CUSTOMER): 121658 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/26/fafc4850-b7d8-4149-91b6-8d115ab76d54_20250626T16:01_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I mean, I just need to check claim status.
[AGENT][NEUTRAL] OK, I can help you with claim status. Can I get your name and a good callback number?
[CUSTOMER][NEUTRAL] [PII] [PII] that's my direct line.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, thank you, [PII]. And you have the policy number for the patient?
[CUSTOMER][NEUTRAL] Uh, uh, it is 254-460-8.
[AGENT][NEUTRAL] Patient name and date of birth.
[CUSTOMER][NEUTRAL] [PII], his date of birth is [PII].
[AGENT][NEUTRAL] And what was the date of service and bill charges?
[CUSTOMER][NEUTRAL] That is [PII] for $830.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Looks like I called.
[CUSTOMER][NEUTRAL] Um, on see.
[CUSTOMER][NEUTRAL] On the [PII] and um I spoke with [PII] and she stated this claim had the dental ID number and it needed to have the medical so I updated it and submitted it to payer ID 64556 and that was on the [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is this for the physician charge or the facility charge?
[CUSTOMER][NEUTRAL] Uh, facility.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, we have a claim for 8.
[CUSTOMER][NEUTRAL] And it's for 800.
[AGENT][NEUTRAL] Uh, 8:33. Is that right?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I think you guys already had it on file and it had the dental number and it needed the medical number so I'm guessing I probably should have submitted as a corrected claim is it denying duplicate?
[AGENT][NEUTRAL] Um, let me see, looks like.
[AGENT][NEUTRAL] Yeah, it looks like we, we did receive it originally and processed it on 2 received it 23, processed on 26.
[CUSTOMER][NEUTRAL] He
[AGENT][NEUTRAL] Um, it looks like it was tied for
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, claim submission received was noted as an accident or injury.
[AGENT][NEUTRAL] And this doesn't have any benefits payable for accident or injury, only sickness.
[CUSTOMER][NEUTRAL] OK, um, was that for?
[CUSTOMER][NEUTRAL] The physician claim or the because there's two claims one for 650 and one for 833.
[AGENT][NEUTRAL] Yeah, that's for the 8:33.
[CUSTOMER][NEUTRAL] OK, because I do show where this uh physician claim has been paid, but I don't have.
[CUSTOMER][NEUTRAL] The UB
[CUSTOMER][NEUTRAL] The facility claim, so is the facility claim patient responsibility?
[CUSTOMER][NEUTRAL] Is that what you're studying?
[AGENT][NEUTRAL] Uh, no, we can't, I mean, I can't state if it's patient responsibility where this is a supplemental policy. It's not like a major medical, so, um, I don't have a physician claim paid either. Um, we don't have a physician claim paid. So maybe it was paid by a different carrier.
[CUSTOMER][NEUTRAL] No, it was paid by you guys.
[CUSTOMER][NEUTRAL] We have a remit for it.
[AGENT][NEUTRAL] What was the payment amount?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] 650 no 250.
[AGENT][NEUTRAL] I know
[CUSTOMER][NEUTRAL] And that was on 218.
[AGENT][NEUTRAL] Don't show any payments made on that by us.
[AGENT][NEUTRAL] Um, but, but for this claim, it was denied due to the diagnosis, so.
[AGENT][NEUTRAL] Do you want me to send over an EOB or?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] This was denied for the diagnosis code?
[AGENT][NEUTRAL] Yeah, so they don't have any, this is a very limited hospital indemnity plan. It's not like a, like I said, like a major medical, so it has very limited benefits.
[AGENT][NEUTRAL] It it won't pay for any uh diagnosis of sickness or accident or injury.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, then I'm gonna invite this to the patient thing because this is an emergency room visit, so.
[CUSTOMER][NEUTRAL] If that's not covered under the plan, that's the only insurance I have to bill, so.
[CUSTOMER][NEUTRAL] Um, can I get just a, uh, reference number from you and your name?
[AGENT][NEUTRAL] A reference number is my name, [PII], first initial to last name [PII], and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK, thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too.