AccountId: 011433970860
ContactId: 29e75100-b568-4c4a-a813-474eee79baad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 564530 ms
Total Talk Time (AGENT): 121695 ms
Total Talk Time (CUSTOMER): 134433 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/29e75100-b568-4c4a-a813-474eee79baad_20250429T13:09_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello. Hi. My name is [PII] calling from provider's office Du Page Medical Group. How are you, how are you, ma'am?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][POSITIVE] I'm good. Actually, I'm looking for a claim status. Can you help with it?
[AGENT][NEUTRAL] Um, yes, ma'am. I can assist you with claim status. Um, first, I'll need your name again and a callback number just in case we're disconnected.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure. My name is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And my callback number is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] Sure. The policy number is gonna be 02542962.
[AGENT][NEUTRAL] OK, thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Uh, patient name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK. Thank you. Now I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] Uh, date of service is [PII] and total charge is 5671.
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, I'm still waiting on my system. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Yes, ma'am. Thanks for your patience. Um, I'm showing that we received this claim on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The claim processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The claim number is 3,544,910.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm showing that the claim paid out for $50 and it paid out that amount because under this policy for outpatient services, including office visits, we cover up to $50.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Only you cover $50 right?
[AGENT][NEUTRAL] Yes, ma'am, for office visits.
[CUSTOMER][NEUTRAL] OK. And then can you explain uh the denialism one more time?
[AGENT][NEUTRAL] Well, I'm showing that this claim paid out for $50.
[AGENT][NEGATIVE] It didn't deny. It paid out for $50 and the remainder of the, the first line paid and the remainder of the lines denied because the $50 benefit maximum was reached on the first line.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is the dollar amount to?
[CUSTOMER][NEUTRAL] Um, exhausted, right?
[AGENT][POSITIVE] Yes, ma'am. That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And uh how much allow?
[AGENT][NEUTRAL] $50.
[CUSTOMER][NEUTRAL] $50 OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] Uh hello. Yeah, I'm not able to show the amount $50 we paid.
[AGENT][NEUTRAL] OK, let's see if we were looking at the same claim. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have a claim number?
[CUSTOMER][NEUTRAL] Yes, I have.
[AGENT][NEUTRAL] What's the claim number?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, the claim number is 202412174147.
[AGENT][NEUTRAL] OK, that's not one of our claim numbers.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And uh may I know the CPT which is paid with $50?
[AGENT][NEUTRAL] The CPT that was paid is the 99213.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For 1211, 24, right?
[CUSTOMER][NEUTRAL] Oh, yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] On the same day, right?
[AGENT][NEUTRAL] Yes, on the same day, on 12-11-24.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me check. Uh, can you hold for one minute?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] OK thank you.
[CUSTOMER][NEUTRAL] OK, I'm showing it's paid.
[CUSTOMER][NEUTRAL] The CPT 99213 OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] No, thank you. Last, uh, may I know the callerence number before ending the call?
[AGENT][NEUTRAL] Yes, for the
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. My name is [PII]. It's spelled [PII] Last initial [PII], and today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you so much, [PII]. Nice to talk with you. Have a great day. Bye.
[AGENT][NEUTRAL] You do the same, Chive. Thank you for calling APL. bye.
[CUSTOMER][NEUTRAL] Mhm bye.