AccountId: 011433970860
ContactId: 25a3b0c7-ce0a-49a4-bcc5-941f52dbb351
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 298269 ms
Total Talk Time (AGENT): 104251 ms
Total Talk Time (CUSTOMER): 96006 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/25a3b0c7-ce0a-49a4-bcc5-941f52dbb351_20250424T18:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, this is initial. This is [PII] as AM [PII] initial [PII] from provider's office to check status. How are you doing today?
[AGENT][NEUTRAL] OK, um, I could check on a claim status. uh, [PII], can I get a good call back number for you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII].
[AGENT][NEUTRAL] OK, thank you for that. Uh, and then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, uh, so the policy number which I have for this patient is 02166656.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. Uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, that was [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and then do you have that bill amount?
[CUSTOMER][NEUTRAL] Yes, that is $557.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[AGENT][NEUTRAL] [PII], do you have the uh tax ID for this provider?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] Uh, just to confirm, that was [PII]?
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so I did find one claim uh for this state of service from this provider, Sam, and that was for um $536.10.
[CUSTOMER][NEUTRAL] $536 is it $557 I think so that is for [PII].
[AGENT][NEUTRAL] This was [PII].
[AGENT][NEUTRAL] Yes, um, let me look at what was submitted originally. Give me just a moment.
[AGENT][NEUTRAL] Was it for, um, is that two procedure codes on this claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, one is 99215 and one is 93,000.
[AGENT][NEUTRAL] OK, OK, so then that is this one, alrighty, so for this claim we did pay the benefit for the 93,000 and that was $21.10 and give me just a moment we were unable to pay the other as uh office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] OK, and could you spell out your name for me?
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Could you spell out your name for me?
[AGENT][NEUTRAL] Sure, it's [PII]
[CUSTOMER][NEUTRAL] Last initial it's [PII], right?
[AGENT][NEUTRAL] Yes, uh, last initials [PII]
[CUSTOMER][NEUTRAL] OK, and I just want to know that.
[CUSTOMER][NEUTRAL] For that CCT code [PII] got fate.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] What CVC code [PII] is denied.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] Office visit.
[CUSTOMER][NEUTRAL] Office visit services.
[CUSTOMER][NEUTRAL] So is this not covered?
[CUSTOMER][NEUTRAL] And deficient flight?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] So we can will this charges to patient.
[AGENT][NEUTRAL] Uh, we don't say what is patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] OK, and could you help me out with the call reference number?
[AGENT][NEUTRAL] Sure, reference number would just be my first name, last initial, and today's date. And was there anything else I can help you with, [PII]?
[CUSTOMER][POSITIVE] No, thank you so much and have a wonderful day bye bye.
[AGENT][POSITIVE] Of course, thanks for APL you too bye bye.