AccountId: 011433970860
ContactId: 2428faf1-3447-4f9c-aead-a049b6a98eb0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 287510 ms
Total Talk Time (AGENT): 103576 ms
Total Talk Time (CUSTOMER): 90240 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/2428faf1-3447-4f9c-aead-a049b6a98eb0_20250211T17:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, it's [PII]. I'm calling your phone provider's office [PII]. I want to discuss about claim, but I did not catch your name. What's your name?
[AGENT][NEUTRAL] It's [PII], and I'm sorry I missed yours too. What was your name?
[CUSTOMER][NEUTRAL] Uh it's [PII], you spell it [PII]
[AGENT][POSITIVE] Got you. OK, and I can definitely check on a claim for you. Uh, so, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] and you can use extension is [PII].
[AGENT][NEUTRAL] Got it. Thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, I have that. Just give me one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's 01.
[CUSTOMER][NEUTRAL] 994-078 M. Mike Lima 8.
[AGENT][NEUTRAL] OK, thank you and what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] The name is [PII].
[CUSTOMER][NEUTRAL] And the date of birth, it's [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. So can I get the date of service for this claim, please?
[CUSTOMER][NEUTRAL] The date of service, it's [PII] for $1,132 even.
[AGENT][NEUTRAL] Got it. OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry, so what was the name of the, uh, provider's office this was with?
[CUSTOMER][NEUTRAL] It's Orthopedic New Jersey LLC.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you believe I've found it. Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so yes, we did receive this claim.
[AGENT][NEUTRAL] Look, there were a few items on here.
[AGENT][NEUTRAL] Alright, so for the procedure code 99204, we were unable to pay that benefit as office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] When the claim was received?
[AGENT][NEUTRAL] Oh, give me just a moment. Let me get that for you.
[AGENT][NEUTRAL] That was received [PII] and it was processed.
[CUSTOMER][NEUTRAL] Same number, please.
[AGENT][NEUTRAL] Uh huh, uh, the claim is processed on, uh, [PII]. The claim number is 35583777.
[CUSTOMER][POSITIVE] Thank you. And the clean wash.
[CUSTOMER][NEUTRAL] [PII]. And you said the one line item is denied, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Correct, so the 99204 office visits are not covered under this policy. Uh, the J3301, that amount was applied toward their deductible.
[CUSTOMER][NEUTRAL] So there is only uh responsibility for the second insurance, the $50 and how much you guys paid?
[AGENT][NEUTRAL] That amount was went towards their deductible.
[CUSTOMER][NEUTRAL] The $50 is the patient uh applied to patient deductible, right?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And if you'd like I can send you a copy of this EOB.
[CUSTOMER][NEUTRAL] Uh, no, thank you. If you said so, it's true. So.
[CUSTOMER][NEUTRAL] Uh, what's the call reference number?
[AGENT][NEUTRAL] It would just be my first name, last initial, and today's date, uh, so my last initial is [PII] and was there anything else I could help you with?
[CUSTOMER][NEGATIVE] No thank you so much for that that's it.
[AGENT][POSITIVE] OK, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You as well. Bye.
[AGENT][POSITIVE] Thank you. Bye-bye.