AccountId: 011433970860
ContactId: 29fcfeb1-1c8e-40af-beb3-b3ecbeda257c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 370589 ms
Total Talk Time (AGENT): 115092 ms
Total Talk Time (CUSTOMER): 104247 ms
Interruptions: 5
Overall Sentiment: AGENT=0.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/29fcfeb1-1c8e-40af-beb3-b3ecbeda257c_20250319T17:26_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from provider's office, checking the claims.
[AGENT][POSITIVE] Good afternoon.
[AGENT][POSITIVE] Sure, I can assist you with claim status. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] The patient policy number 01660281 M for [PII], L for Lima.
[CUSTOMER][NEUTRAL] 8
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] and the date of birth, [PII].
[AGENT][NEUTRAL] OK. What's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] D of service 116-2024.
[CUSTOMER][NEUTRAL] The total bill amount is $342.36.
[AGENT][NEUTRAL] No, it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] or 15?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, what is the procedure code? I got a bunch of duplicates here.
[CUSTOMER][NEUTRAL] What is it I see here.
[CUSTOMER][NEUTRAL] Yeah, the procedure code 992,147,360.
[AGENT][NEUTRAL] OK, so, OK, let me go to the original one. Looks like it's been processed quite a few times.
[CUSTOMER][NEUTRAL] I guess the process.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so the original claim was passed on [PII].
[CUSTOMER][NEUTRAL] OK, so the original claim on [PII].
[AGENT][NEUTRAL] And we send a benefit amount of $32.71 and this was for procedure code 73,630. And the office visit is not covered under the member's plan.
[CUSTOMER][NEUTRAL] $32.71 this was her procedure of 73,630.
[CUSTOMER][NEUTRAL] And the office is not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Office visit is not called on the member's plan. Could you help me with the exact reason why it is not called?
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] It's just not covered. It's not a cover service under the member's plan.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Mhm. May I know the policy?
[CUSTOMER][NEUTRAL] Patient policy name?
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical.
[CUSTOMER][NEUTRAL] Secondly, supplemental plan.
[AGENT][NEUTRAL] Mhm. Right.
[CUSTOMER][NEUTRAL] And may I know why it is not called? Could you help me with that reason?
[AGENT][NEGATIVE] It's just not covered. It's, it's not a reason why it's not covered. It's just not covered under the member's plan. It's not part of his benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And what, what about other procedure?
[AGENT][NEUTRAL] The procedure code 73,630, that was paid. We send a benefit of $32.71. That is a treatment or um procedure done in the office. That part is covered. The only, the only part we do not cover is the visit.
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] Any
[CUSTOMER][NEUTRAL] Um, in the office that part is covered. The only, the only part is not covered is to visit.
[AGENT][NEUTRAL] The co-payment for the visit is not covered under the policy.
[CUSTOMER][NEUTRAL] Oh it's not.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] As per policy, office it will, is not covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I will see previously we do receive payments for office visit.
[AGENT][NEUTRAL] What date was the claim number?
[CUSTOMER][NEUTRAL] Same patient.
[CUSTOMER][NEUTRAL] Just give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just give me a moment.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, mm, I don't see any example. Could you help me with the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's state if you will.
[CUSTOMER][NEUTRAL] Can you spell your name for my documentation?
[AGENT][NEUTRAL] My name is [PII]'s [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Mm, OK. Thank you so much. That's it for the day. Have a great day. Bye.
[AGENT][POSITIVE] Yes ma'am. Thank you for calling APM. Bye bye.