AccountId: 011433970860
ContactId: 3a96a85e-de6f-4b96-8521-b20455c315d2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 476869 ms
Total Talk Time (AGENT): 130956 ms
Total Talk Time (CUSTOMER): 64395 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=-1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/3a96a85e-de6f-4b96-8521-b20455c315d2_20250320T14:24_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 [PII], this is [PII], and I'm calling from provider's office regarding claim status.
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, that would be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, what's the name of the facility or the provider you're calling from?
[CUSTOMER][NEUTRAL] That's ambulatory surgery center of Spartanburg.
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, uh, that would be Delta 43301675.
[AGENT][NEUTRAL] Um, do you see a policy certificate number? It's gonna start with a 0 followed by 7 digits.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] 02461193
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It's [PII], [PII].
[AGENT][NEUTRAL] OK, perfect. Thank you. And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] That's [PII] for the Street $1,595 even.
[AGENT][NEUTRAL] OK, so that's [PII] $3,595 evening, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me see if I can find this claim for you. And for future, you can check claim status online through our website at [PII]. And do you mind holding for me while I search for that claim?
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you. One moment.
[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][NEUTRAL] Thank you for holding and being patient for me. OK, so it looks like um we have processed this claim on [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And we send a benefit amount of $77.20 to the provider.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you need the claim number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, the claim number is 3569726.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] Can I know when was the claim received on?
[AGENT][NEUTRAL] OK, let me get that for you. That's not on the I'll be one moment.
[AGENT][NEUTRAL] See
[AGENT][NEUTRAL] It was received [PII].
[CUSTOMER][NEUTRAL] OK. Uh, what was the allowed and allowed amount?
[AGENT][NEUTRAL] Um, the benefit amount is $77.20. We are the secondary, and it looks like we cover um the procedure code um 55,700. Now, the procedure code 76872 was denied because the only diagnostic benefits we cover is MRI, CT scan, or colonoscopy only.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, can I have a reference number for the call?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] Uh, can you just spell your name for me?
[AGENT][NEUTRAL] Sure. That's [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] I think that's all for now.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.