AccountId: 011433970860
ContactId: 429d3f88-fbe1-4803-8525-d050efa60150
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 402119 ms
Total Talk Time (AGENT): 108719 ms
Total Talk Time (CUSTOMER): 115672 ms
Interruptions: 3
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/429d3f88-fbe1-4803-8525-d050efa60150_20250512T16:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from the provider office. I need to check the client status.
[AGENT][NEUTRAL] OK, I can help you. What's the policy number?
[CUSTOMER][NEUTRAL] Policy number is D as in Delta 420.
[CUSTOMER][NEUTRAL] 0531 9
[AGENT][NEUTRAL] Can you spell the patient's first and last name, please?
[CUSTOMER][NEUTRAL] Patient first name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] The last name is [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And is this a medical claim?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what's the date of birth, uh, for the patient?
[CUSTOMER][NEUTRAL] The date of birth of the patient is on.
[CUSTOMER][NEUTRAL] [PII] of uh
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you for that information and what is the date of service for the claim and we can help you?
[CUSTOMER][NEUTRAL] Day of services on [PII].
[CUSTOMER][NEUTRAL] For 200.
[AGENT][NEUTRAL] You said December, I'm sorry, 200.
[CUSTOMER][NEUTRAL] Second
[CUSTOMER][NEUTRAL] It is [PII] for $229 even.
[AGENT][POSITIVE] OK, thanks.
[AGENT][NEUTRAL] And the procedure codes on the claim?
[CUSTOMER][NEUTRAL] Postal codes are [PII] and [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Can you please spell your name?
[AGENT][NEUTRAL] Mhm. It's [PII] A, first initial last name is [PII] and you'll use my name in today's date as reference for today's claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, so.
[AGENT][NEUTRAL] The maximum calendar your benefit um is has been exhausted or is exhausted for that office visit charge.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see. For the office visit charge and for the treatment code, then a puncture was denied is not covered by the patient's policy.
[CUSTOMER][NEUTRAL] Ah, I need to know.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, I need to know what is the maximum benefit for a year and when it was met.
[AGENT][NEUTRAL] It's up to $50 per day. Uh, they're entitled to 2 days per calendar year. One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it was met on [PII].
[CUSTOMER][NEUTRAL] OK. What are the two dates that it paid?
[AGENT][NEUTRAL] OK, so it's from another provider so we can't disclose that information?
[CUSTOMER][NEUTRAL] Uh, just the day
[AGENT][NEUTRAL] That's the name I just gave you.
[CUSTOMER][NEUTRAL] One is [PII] is the last time it was paid, right?
[AGENT][NEUTRAL] OK, so do you already have the information?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So we can build the patient for this one, right? All the three codes?
[AGENT][NEUTRAL] We cannot advise. We do not determine patients responsibility.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But uh the EOB says we can bill the patient for $71.49.
[AGENT][NEUTRAL] Our EOB does not say that. It just says that the maximum benefit is exhausted. It doesn't say that you can build the patient and we're not at liberty to say that. So it's up to the provider's discretion.
[CUSTOMER][NEUTRAL] Is it the one?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What is the claim number?
[AGENT][NEUTRAL] The claim number for your date of service 212-224 for 229 is 354-1975.
[CUSTOMER][NEUTRAL] 1975.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Thanks for your assistance and have a great day.
[AGENT][POSITIVE] All right. Anything else I can help out with today? All right.
[CUSTOMER][NEUTRAL] Mm that's it for the day.
[AGENT][POSITIVE] Uh, you too. Thanks for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Have a good day.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] And.
[AGENT][NEUTRAL] [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]. It is a direct number.
[AGENT][NEUTRAL] OK, and did you have any other questions?
[CUSTOMER][POSITIVE] Yeah, that's it for the day. Uh, have a great day.
[AGENT][POSITIVE] All right. Thanks for calling APL. Have a good day as well.
[CUSTOMER][NEUTRAL] Mhm.