AccountId: 011433970860
ContactId: 396b6644-d01f-490d-a72d-e7451b436380
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 638250 ms
Total Talk Time (AGENT): 113216 ms
Total Talk Time (CUSTOMER): 92973 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/396b6644-d01f-490d-a72d-e7451b436380_20250321T17:19_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, um, good afternoon. Uh, this is [PII], and I am calling for Prisma Health checking on claim status. Please be informed that this call is recorded for quality and training purposes, and I am so sorry, ma'am. Did I get your name right? [PII]?
[AGENT][NEUTRAL] Yes, that is correct. Last initial [PII].
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] All right.
[AGENT][POSITIVE] Mhm thank you. And may I have a callback number just in case we get disconnected, Ms. [PII].
[CUSTOMER][NEUTRAL] Yeah, that would be [PII].
[AGENT][NEUTRAL] OK, I got [PII] and the middle numbers got cut off. Can you repeat the middle numbers?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] [PII]. OK, and that's [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 01973300.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Member's name is [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] OK, perfect, thank you. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Date of service is [PII]. The total charge amount on the claim is $218 even.
[AGENT][NEUTRAL] OK, so [PII] is the date of service, correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the procedure code?
[CUSTOMER][NEUTRAL] Mexico like
[CUSTOMER][NEUTRAL] Uh, the procedure code billed is 99215.
[AGENT][NEUTRAL] That sorry.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Let me put this'll be a moment.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Bear with me just a minute, I'm waiting on the EOB.
[CUSTOMER][NEUTRAL] Oh, all right, all right.
[AGENT][NEUTRAL] I'm still waiting.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it looks like we processed the claim on [PII].
[AGENT][NEUTRAL] And the claim was um processed and all payable benefits was applied towards the policy deductible.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] How much was applied towards the deductible?
[AGENT][NEUTRAL] $40.
[CUSTOMER][NEUTRAL] $40. All right.
[CUSTOMER][NEUTRAL] So is that the allowed amount as well?
[AGENT][NEUTRAL] Um, I'll have to check the major medical EOB because we're just a secondary. Let me see. Bear with me.
[AGENT][NEUTRAL] OK, based on the primary ELB um with Cigna, they apply $40 towards the copayment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, and are you able to send us um a copy of the EOB?
[AGENT][NEUTRAL] Yes, what is the fax number?
[CUSTOMER][NEUTRAL] All right, so fax number would be.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, to your attention, Miss [PII].
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you mind holding for me while I send it?
[CUSTOMER][NEUTRAL] And that would be the turnaround time.
[AGENT][NEUTRAL] A few minutes. I just need to send it before I let you go, OK? So I'm gonna put you on a brief hold, OK? Thank you.
[CUSTOMER][NEUTRAL] Oh, OK. All right.
[CUSTOMER][NEUTRAL] All right.
[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 me, Ms. [PII]. Yeah, I went ahead and send that over to you. It should be there in a few minutes. Is there anything else that I'll help you with today?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Yeah, I'll just uh be getting a call reference number.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name and today's date if you will.
[CUSTOMER][POSITIVE] Alright, thank you so much for your time and for assisting me today and you have a great day.
[AGENT][POSITIVE] You're welcome. You as well, and thank you for calling APL. Have a good day. Happy weekend.
[CUSTOMER][NEUTRAL] Bye. Mhm.
[AGENT][NEUTRAL] Bye-bye.