AccountId: 011433970860
ContactId: 1f8f6dbb-b4e7-4482-9b97-de9e57ed959f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 273579 ms
Total Talk Time (AGENT): 113695 ms
Total Talk Time (CUSTOMER): 87272 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/1f8f6dbb-b4e7-4482-9b97-de9e57ed959f_20250212T16:43_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, hi, my name is [PII], and I'm calling from Piedmont Healthcare calling to check claim status for a member.
[AGENT][POSITIVE] OK, sure, I can assist you with claim status.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII] and [PII] [PII].
[AGENT][NEUTRAL] OK, [PII]. All right. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, 01163054.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright.
[AGENT][NEUTRAL] And what is the name and date of birth of the patient, Miss [PII]?
[CUSTOMER][NEUTRAL] Yeah, OK, it's [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] And you said you need claim status for what date of service?
[CUSTOMER][NEUTRAL] Um, data service [PII].
[AGENT][NEUTRAL] How much is the total charge?
[CUSTOMER][NEUTRAL] OK, I have actually two buildouts they split because of the two different physicians, but I have $17 and then $195.
[AGENT][NEUTRAL] OK, let me check and see if I have those claim.
[AGENT][NEUTRAL] And for future you can check claim status online through our website at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, you said [PII] at and what was that?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. All right, let me go ahead and pull this to claims, um, bear with me just a second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, it looks like they both denied for the same reason.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I still waiting on the paper. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so it looks like it was denied um stating on [PII], that's when it was denied, stating calendar year policy maximum of 4 doctor's office visit per person has been met.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, per person, OK, alright, so then, um, did an are you able to see if an explanation of benefits went out to the provider in indicating that? OK, alright, so we'll definitely allow some time, um, will I be able to get a claim number for each line.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, I can give you a claim number for each amount. Yes. Mhm. The, yes, the claim number for the $195 is 3558053.
[CUSTOMER][NEUTRAL] Yeah, each amount, yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the claim number for the $17 is 3,558,050.
[CUSTOMER][NEUTRAL] OK great alright I'll allow time for that and then um what is your name again? It cut out at the beginning and I couldn't catch it.
[AGENT][NEUTRAL] It's OK. My name is [PII].
[CUSTOMER][NEUTRAL] OK and then do you also provide call reference numbers?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date if you will.
[CUSTOMER][POSITIVE] OK, all right, I definitely will well again thank you so very much and you have a lovely rest of your week.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You as well, Missy and thank you for calling ATM. Have a good day. Bye-bye.
[CUSTOMER][POSITIVE] Yes thank you uh huh bye bye.