AccountId: 011433970860
ContactId: 0b010c59-4751-43e4-ad30-a156e1c31c75
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 318149 ms
Total Talk Time (AGENT): 87140 ms
Total Talk Time (CUSTOMER): 130430 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/0b010c59-4751-43e4-ad30-a156e1c31c75_20250512T19:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, sir. Very good afternoon. This is [PII] from Medical Clinic of North Texas, and there is a claim I wanted to discuss about. Could you please help me with that?
[AGENT][NEUTRAL] I'm happy to check on a claim. What is the policy number for the patient?
[CUSTOMER][NEUTRAL] It is D delta 412.
[CUSTOMER][NEUTRAL] 03513
[AGENT][NEGATIVE] Unfortunately, I can't.
[CUSTOMER][NEUTRAL] [PII], what's the last name in?
[CUSTOMER][NEUTRAL] Oh, go on.
[AGENT][NEUTRAL] My last name initial is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Unfortunately, I can't pull the number with that number. Do you have their card in front of you?
[CUSTOMER][NEUTRAL] What kind of info do you need?
[AGENT][NEUTRAL] I need the policy certificate number.
[CUSTOMER][NEUTRAL] OK, I don't know about the policy certificate number. Just a second.
[CUSTOMER][NEUTRAL] I have to check what I have for you. Hold on a second.
[CUSTOMER][NEUTRAL] I think I do not have the ID card, but still, I will check.
[AGENT][NEUTRAL] Do you have the claim number by chance?
[CUSTOMER][NEUTRAL] Maybe I will find something.
[CUSTOMER][NEUTRAL] Yeah, I do have the claim number.
[AGENT][NEUTRAL] What's the claim number?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] The UB is not showing me the claim number, but I think the policy number is 02585552. That's the policy number I can oh I found the claim number as well 35793 and 25 I guess at the end, not 263579326.
[AGENT][POSITIVE] Alright thank you give me just one moment please.
[CUSTOMER][NEUTRAL] Sure, so.
[CUSTOMER][POSITIVE] So let me also inform you about our call is from a recording and I hope you don't mind about it.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name and date of birth is [PII]. Her date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. So, the claim that number that you gave me looks like there was a benefit uh payment sent for 175. What questions or concerns did you have?
[CUSTOMER][NEUTRAL] Yeah, I can see the claim has been paid, but somehow it just denied for one code that is 81001 but.
[CUSTOMER][NEUTRAL] I don't know the specific denial reason at my end I can see this is only denying for non-covered charges. May I know why?
[AGENT][NEUTRAL] Uh, the calendar maximum for the wellness benefit had already been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] In this claim, right, the $137 has been paid, and that is the limit.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Correct. So there was nothing additional payable.
[CUSTOMER][NEUTRAL] OK, fine.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] How much dollar amount can policy pay for the lab visits?
[AGENT][NEUTRAL] For a lab visit?
[CUSTOMER][NEUTRAL] Yeah, these are the labs, but these labs are for the preventive reason.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] The patient's plan allows one wellness exam or test benefit with a benefit amount of $75.
[CUSTOMER][NEUTRAL] For the land.
[AGENT][NEUTRAL] For a lab or wellness exam, yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you need me to check on anything else?
[CUSTOMER][NEUTRAL] Uh, no, just, can I have a reference number for our conversation?
[AGENT][NEUTRAL] Call reference is my name with my last initial and then today's date. My name again is [PII], that is spelled [PII] Last initial to my name is [PII], and then today's date.
[CUSTOMER][NEUTRAL] OK, sir.
[CUSTOMER][POSITIVE] Thanks for your help. You've been very sweet and have a good day then. Bye for now.
[AGENT][NEUTRAL] You too bye bye.
[CUSTOMER][NEUTRAL] OK