AccountId: 011433970860
ContactId: 2ae60c69-8225-4dbf-a887-b321881b5c4b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 594270 ms
Total Talk Time (AGENT): 144888 ms
Total Talk Time (CUSTOMER): 92888 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/2ae60c69-8225-4dbf-a887-b321881b5c4b_20250320T13:20_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I am calling for claim status please.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status and may I have your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And Ms. [PII], are you calling from provider's office?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's your personal policy?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] It's your personal policy or you're calling for a provider?
[CUSTOMER][NEUTRAL] Calling from a provider's office.
[AGENT][NEUTRAL] OK, thank you, Ms. [PII]. May I have the name of the facility and the phone number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's Ortho Sensei.
[CUSTOMER][NEUTRAL] My phone number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 025.
[CUSTOMER][NEUTRAL] 825.
[CUSTOMER][NEUTRAL] 61.
[AGENT][NEUTRAL] Thank you. May I have the name and date of birth?
[AGENT][NEUTRAL] Birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII], and may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Uh, data service is 124 25.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And total charge.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] Is 861.
[AGENT][NEUTRAL] OK. All right, let me see if I can find this claim and for future, you can check claim status online through our website at [PII] and that's just optional. You can always call um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Let me pull up this explanation of benefits and see if you if your claim. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm still waiting on the system.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, looks like we processed the claim on [PII] and we send a benefit amount of $175 to the provider.
[AGENT][NEUTRAL] And that is the maximum benefit for the policy.
[CUSTOMER][NEUTRAL] OK, so the.
[CUSTOMER][NEUTRAL] Radilogy charges and the.
[CUSTOMER][NEUTRAL] Um, injection.
[CUSTOMER][NEGATIVE] The J code itself you guys don't cover that. That's not a covered benefit.
[AGENT][NEUTRAL] Um, it's not that it's not covered, is that with the payment of the 175, the member has exhausted the benefit for that date of service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, this one pays flat amounts. Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The 175 is the maximum per day.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then may I please get so uh yes, may I please get the claim number?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Sure. The claim number is 3561499.
[CUSTOMER][NEUTRAL] 14, what were the other numbers?
[AGENT][NEUTRAL] 99.
[CUSTOMER][NEUTRAL] OK, are you able to fax me or email me a copy of that EOB?
[AGENT][NEUTRAL] Sure, yes, I can fax it over, Ms. [PII]. What is the fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 286 5.
[AGENT][NEUTRAL] OK. [PII] to your attention.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][POSITIVE] Not at all, thank you.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for you, Ms. [PII]. I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I'm gonna help you with today?
[CUSTOMER][NEUTRAL] No thank you, just your name and reference number.
[AGENT][NEUTRAL] My name is [PII]. That's [PII] as [PII]. Last initial [PII], and we don't have reference numbers. You can use my name in today's date.
[CUSTOMER][POSITIVE] OK, well thank you so much for your time today so you have a wonderful day.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] You as well, Ms. [PII]. Thank you for calling ATL. Goodbye.
[CUSTOMER][POSITIVE] Thank you. Bye.
[AGENT][NEUTRAL] Yeah