AccountId: 011433970860
ContactId: 216dcdbf-d8d0-4582-9325-39ebb9ae4f31
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 657859 ms
Total Talk Time (AGENT): 158213 ms
Total Talk Time (CUSTOMER): 157137 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/216dcdbf-d8d0-4582-9325-39ebb9ae4f31_20250218T20:08_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Thank you for calling. Hi, [PII]. I'm [PII] calling from the. That's all checking on the client that's [PII]. Last name is [PII].
[AGENT][POSITIVE] Thank you [PII]. I'm happy to check on a claim for you today. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Just on
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's going to be
[CUSTOMER][NEUTRAL] 022556
[CUSTOMER][NEUTRAL] 74
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you, [PII]. And if I can get patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is going to be [PII] for [PII].
[AGENT][NEUTRAL] Thank you for that and then what's the date of service?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] Just the.
[CUSTOMER][NEUTRAL] Data service is going to be level 5 2024 $189.60.
[AGENT][NEUTRAL] No claims on file for [PII].
[CUSTOMER][NEUTRAL] May, the number is active?
[AGENT][NEUTRAL] Uh yes, member was active. The effective date.
[AGENT][NEUTRAL] On the patient plan is [PII], patient is still active.
[CUSTOMER][NEUTRAL] OK. Is there any rejection on file?
[AGENT][NEUTRAL] Is there any restriction on, I'm sorry, what?
[CUSTOMER][NEUTRAL] Rejection
[AGENT][NEGATIVE] No, not for that patient.
[CUSTOMER][NEUTRAL] Where is the family file limit to submit the claim?
[AGENT][NEGATIVE] There's no timely filing.
[CUSTOMER][NEUTRAL] May I know the mailing address and pay ID?
[AGENT][NEUTRAL] Uh, mailing address is going to be [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII]. Zip code is [PII].
[CUSTOMER][NEUTRAL] Could you please repeat the [PII]?
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Payer ID?
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][NEUTRAL] OK, so now let me check. I have uh next data service for this different number.
[AGENT][NEUTRAL] A different member you need to check?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Just a minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's going to be.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 02518903.
[AGENT][NEUTRAL] Thank you and patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK. And
[AGENT][NEUTRAL] Data service
[CUSTOMER][NEUTRAL] Data service [PII].
[CUSTOMER][NEUTRAL] Sorry, [PII], 24, 2024.
[AGENT][NEUTRAL] OK, and the bill amount?
[CUSTOMER][NEUTRAL] That's 282 6.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] We did receive this claim. It looks like on [PII].
[AGENT][NEUTRAL] There was a benefit payment sent in the amount of $92.46.
[AGENT][NEUTRAL] And this was processed on [PII].
[CUSTOMER][NEUTRAL] What about
[CUSTOMER][NEUTRAL] OK. What about code 99213?
[CUSTOMER][NEGATIVE] I think it's denied.
[CUSTOMER][NEUTRAL] There's no payment for 99213.
[AGENT][NEGATIVE] That was denied.
[AGENT][NEGATIVE] Yeah, it was denied office visits are not covered under the member's policy.
[CUSTOMER][NEUTRAL] May I know the policy name?
[AGENT][NEUTRAL] I'm sorry, what was that again? Oh, the plan name this is there.
[CUSTOMER][NEUTRAL] Planning
[CUSTOMER][NEUTRAL] What is the plan name?
[AGENT][NEUTRAL] Red link
[CUSTOMER][NEUTRAL] Sorry, could you please spell that?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] So under the meddling plan, the patient offer usage is not covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Where's the claim number.
[AGENT][NEUTRAL] 3347194.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] 354.
[CUSTOMER][NEUTRAL] 264.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 7194.
[CUSTOMER][NEUTRAL] OK, sir, let me check the next number ID.
[CUSTOMER][NEUTRAL] This is a different number.
[AGENT][NEUTRAL] Different policy.
[CUSTOMER][NEUTRAL] Let me check the number.
[CUSTOMER][NEUTRAL] That's going to be
[CUSTOMER][NEUTRAL] 09711.
[CUSTOMER][NEUTRAL] 953 1.
[AGENT][NEUTRAL] You said 097119331?
[CUSTOMER][NEUTRAL] 9534.
[AGENT][NEUTRAL] That doesn't come up as a valid member policy number. Do you have their name or social?
[CUSTOMER][NEUTRAL] Let me check the sources.
[CUSTOMER][NEUTRAL] Uh, and then.
[CUSTOMER][NEUTRAL] OK. Uh, let me give you the last name. That's [PII], that's [PII]. The first name [PII].
[CUSTOMER][NEUTRAL] I, uh, you want me to spell that? [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Do you have a claim number or anything like that for the date of service?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, not able to find a member's plan under that name.
[CUSTOMER][NEUTRAL] OK, sir. May I know the car reference number?
[AGENT][NEUTRAL] Call reference is my name with my last initial and today's date.
[CUSTOMER][POSITIVE] Thank you for the information. Have a great day, bye.
[AGENT][NEUTRAL] You too [PII] bye bye