AccountId: 011433970860
ContactId: 0eb594ec-e002-4c2c-b10e-ff7f57aa5f5a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 424290 ms
Total Talk Time (AGENT): 152370 ms
Total Talk Time (CUSTOMER): 157160 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/0eb594ec-e002-4c2c-b10e-ff7f57aa5f5a_20250217T16:20_UTC.wav
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[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] [PII], this is [PII] in the cancer cure. Um, I have, uh, policy 1,972,970.
[CUSTOMER][NEUTRAL] This is a provider. I'm gonna spell you his name. I don't know how to pronounce it.
[CUSTOMER][NEUTRAL] He said it's [PII]
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] He's calling on claim 35.
[CUSTOMER][NEUTRAL] 52
[CUSTOMER][NEUTRAL] 649.
[CUSTOMER][NEUTRAL] Where the benefits were applied to the member's deductible.
[CUSTOMER][NEUTRAL] I've explained to him that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He's asking about family plans, what was applied. He was asking stuff I really don't know. So I'm transferring the call, OK?
[AGENT][NEUTRAL] OK, I'm sorry, I'm sorry before you do that, I'm sorry who are you now? I'm so sorry. I didn't, I didn't get that part.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, [PII] OK and the provider's name if you could spell that for me one more time your phone was breaking up [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, did you get a callback number [PII]?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, he's calling in regards to [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK alright thank you so much.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you for calling AI. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII], my name is [PII] and I'm calling from the provider's office, and I want to know the status of the call.
[AGENT][NEUTRAL] OK, I was alright, [PII], I'm sorry, pronounce your name again? I'm so sorry.
[CUSTOMER][POSITIVE] Yes, correct. Yes.
[CUSTOMER][NEUTRAL] Uh, uh, uh, let me spell it out for you. [PII].
[AGENT][NEUTRAL] [PII], OK, and you're calling for claim status now I was provided a claim number and that was 3526499.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Is that right?
[CUSTOMER][NEUTRAL] Uh, that, uh, I'm, uh, I'm not sure about the claim number, but I have the date of service which is 79 of 2024.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, and the total charge amount, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is, I think it is, uh, let me check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, 250.09, right?
[AGENT][NEUTRAL] OK, yes, that is correct, one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, I have that claim pulled up and there is no payment on this particular claim.
[CUSTOMER][NEUTRAL] Uh, OK. What's the
[AGENT][NEUTRAL] I'm sorry, say that one more time.
[AGENT][NEUTRAL] You want to know why the claim denied? OK, thank you. One moment.
[CUSTOMER][NEUTRAL] What's the reason?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you so much one moment.
[CUSTOMER][NEUTRAL] Morning
[AGENT][NEUTRAL] OK, it shows that a portion of the benefits were applied to the deductible.
[AGENT][NEUTRAL] Of the policy
[CUSTOMER][NEUTRAL] Uh, uh, I'm sorry, can you repeat?
[AGENT][NEUTRAL] Of course. It shows that the benefits were applied to the deductible.
[AGENT][NEUTRAL] Now for a procedure
[CUSTOMER][NEUTRAL] OK, so, uh, you process this claim as deductibles.
[AGENT][NEUTRAL] The benefits that were payable went towards the policy's deductible. The plan has a deductible.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. What are, what are the procedure codes that you're telling me?
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Let me get back to that.
[AGENT][NEUTRAL] OK, for procedure code, excuse me, for procedure code A like Alpha, 4604.
[AGENT][NEUTRAL] A like Alpha, 7033. A like Alpha, 7035.
[AGENT][NEUTRAL] A like Alpha, 7046.
[AGENT][NEUTRAL] And A like Alpha, 7034.
[AGENT][NEGATIVE] Procedure code A like Alpha 7038 was not paid.
[CUSTOMER][NEUTRAL] OK. So for
[CUSTOMER][NEUTRAL] Uh, what's the reason why this code is not paid?
[AGENT][NEGATIVE] OK, it was not paid because this is not a covered DM me.
[CUSTOMER][NEUTRAL] OK, it is not covered under the patient's plan, right?
[AGENT][POSITIVE] Correct, because it's disposable.
[CUSTOMER][NEUTRAL] OK. And the remaining codes are uh processed as deductibles, right?
[AGENT][POSITIVE] Correct, went towards the deductible. That is correct.
[CUSTOMER][NEUTRAL] OK. OK. It's a, uh, so can you tell me how much, uh, what's the total amount which uh applied towards deductibles?
[AGENT][NEUTRAL] OK, for a procedure code A 4604 $30.80.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 87033.
[CUSTOMER][NEUTRAL] OK, OK, OK.
[AGENT][NEUTRAL] I'm sorry. Would you like me to continue?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK. Uh, uh, uh, no, no, no.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, it's fine, it's fine. I got that.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Your name is [PII], right?
[AGENT][NEUTRAL] Yes, my name is [PII], last initials [PII].
[CUSTOMER][NEUTRAL] OK, [PII], any kind of conference number for me?
[AGENT][NEUTRAL] Uh, no, you can use my name in today's date. Is there anything else I can assist you with, sir?
[CUSTOMER][NEUTRAL] Oh, can you repeat the claim number for me? Uh, I don't have it.
[AGENT][NEUTRAL] Of course, let me give that claim number to you. I have that as 3526499.
[CUSTOMER][NEUTRAL] 352-64999
[AGENT][NEUTRAL] 352-649-999.
[CUSTOMER][POSITIVE] OK, OK. OK, [PII], thank you so much. I got it. That's it from my side. Have a great day ahead.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You as well. Thank you for calling APL. Take care. Bye-bye.