AccountId: 011433970860
ContactId: 45a08a02-a929-44d4-a690-304098d32413
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 182679 ms
Total Talk Time (AGENT): 54314 ms
Total Talk Time (CUSTOMER): 72718 ms
Interruptions: 0
Overall Sentiment: AGENT=2.1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/45a08a02-a929-44d4-a690-304098d32413_20250416T15:17_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling from Oakdale Physical Therapy Services. I am um calling regarding a claim that we submitted on a patient. Do you need the ID number or anything?
[AGENT][NEUTRAL] Oh sure, [PII], I can assist you with claim status. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] OK, it's uh.
[CUSTOMER][NEUTRAL] 02545827
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] and his date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. Now, I need the date of service and bill charges on the claim.
[CUSTOMER][NEUTRAL] OK, the date of service is [PII] through [PII].
[CUSTOMER][POSITIVE] Oh good.
[CUSTOMER][NEUTRAL] And the billing amount was $244.
[AGENT][NEUTRAL] OK, let's see, one moment.
[CUSTOMER][POSITIVE] I do have the explanation of benefits.
[CUSTOMER][NEUTRAL] Um, and a reference number?
[CUSTOMER][NEUTRAL] But in the remarks it says one I guess that's the reason why it wasn't paid but I don't know what one is.
[AGENT][NEUTRAL] OK. Yes, ma'am. I'm showing that this claim denied um because under this policy for outpatient services, we cover up to 1000 per calendar year, including physical therapy charges, and that benefit was maxed out on a previous claim, so that's why it denied.
[CUSTOMER][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And is there anything else I can mhm.
[CUSTOMER][NEUTRAL] So I don't
[CUSTOMER][NEGATIVE] It only covers 1000.
[AGENT][NEUTRAL] Right, per calendar year.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, and what was your name?
[AGENT][NEUTRAL] Um, it's [PII]. It's spelled [PII] and my last initial is [PII].
[CUSTOMER][POSITIVE] OK, easy.
[CUSTOMER][POSITIVE] All right well you thank you.
[AGENT][POSITIVE] OK, thank you, [PII] for mhm.
[CUSTOMER][NEUTRAL] And you
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] Hey, thanks for calling APL. Have a great day, [PII].
[CUSTOMER][NEUTRAL] OK, you too.
[AGENT][POSITIVE] Mm thanks. Bye.