AccountId: 011433970860
ContactId: 48efddf8-e09d-44b6-9d49-0eaf989543ab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 217179 ms
Total Talk Time (AGENT): 91170 ms
Total Talk Time (CUSTOMER): 103128 ms
Interruptions: 4
Overall Sentiment: AGENT=1.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/48efddf8-e09d-44b6-9d49-0eaf989543ab_20250203T22:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, uh, this is [PII] calling from provider's office trying to check on the status of the claim for one of our patients.
[AGENT][NEUTRAL] OK, I could check on a claim for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] Thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, I do. 02286545. M as in Mike, L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you and what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Uh, insured name is [PII].
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII] uh what was the date of service for this claim?
[CUSTOMER][NEUTRAL] Date of service is [PII] with the total bill amount of $301.28.
[AGENT][NEUTRAL] OK thank you one moment please.
[CUSTOMER][NEUTRAL] Tomorrow
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] I you
[AGENT][NEUTRAL] I'm sorry [PII] what was the name of the provider's office this was with?
[CUSTOMER][NEUTRAL] Uh, heart rhythm Consultants PA.
[AGENT][POSITIVE] OK, thank you. I do believe I found this claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So looks like there are 2 of the procedure codes. There were 2 procedure codes on there, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Bear with me just a moment, so.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] We were able to pay the procedure code 93.
[CUSTOMER][POSITIVE] Uh, your voice is getting good.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEGATIVE] Your voice is getting break.
[AGENT][NEUTRAL] Uh oh, can you hear me?
[CUSTOMER][POSITIVE] Uh, yes, quite better now.
[AGENT][NEUTRAL] OK, sorry.
[AGENT][NEUTRAL] OK, so we were unable to pay a benefit for the office visit, so procedure code 99214, uh, as office visits are not covered under this policy. We did pay that benefit for 93,000. We did pay that benefit of $14.58.
[CUSTOMER][NEUTRAL] So for office visit that is not covered under this policy, can we transfer, I mean, can we bill the patient for this?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] We do not say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. So it's providers call. All right. No worries. That's all I wanted to confirm. OK. Could you please help me with the uh spell of your name and then call reference number for my records?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah, um, did you need this claim number, [PII]?
[CUSTOMER][NEUTRAL] Uh, I have the claim number 3541989.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] OK, sure, just wanted to make sure, um, so the reference number would just be my first name, last initial, and today's date. uh so my name is spelled [PII] Was there anything else I could help you with?
[CUSTOMER][NEGATIVE] Uh, no.
[AGENT][POSITIVE] OK, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You as well. Take care. Bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.