AccountId: 011433970860
ContactId: 494aa41f-3c4b-4208-8704-7df5fd7ba77e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 378260 ms
Total Talk Time (AGENT): 170429 ms
Total Talk Time (CUSTOMER): 109060 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/494aa41f-3c4b-4208-8704-7df5fd7ba77e_20250509T12:09_UTC.wav
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[AGENT][NEUTRAL] Hi. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] Hello, I'm [PII] calling from the provider office to check the claim status. How are you doing today?
[AGENT][NEUTRAL] I'm fine, [PII]. And what is that, uh, I can help with the claim status. What is that policy number, please?
[CUSTOMER][NEGATIVE] Uh, I'm unable to hear your voice clearly. Could you speak a bit loud?
[AGENT][NEUTRAL] Yes, uh
[AGENT][NEUTRAL] Uh, [PII], I can certainly help with a with a claim status. What is that, uh, policy number, please?
[CUSTOMER][NEUTRAL] 1440654
[AGENT][NEUTRAL] OK, thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, patient name is [PII] and date of birth is [PII].
[AGENT][POSITIVE] I appreciate that. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Thank you. What date of service are you looking for for [PII]?
[CUSTOMER][NEUTRAL] Uh, [PII] the total bill amount of $198 and.
[AGENT][NEUTRAL] OK, thank you very much. Um, your claim number on this is 3593635.
[AGENT][NEUTRAL] OK, so we need to see when we um.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] When you got that claim.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so it looks like you received the claim.
[CUSTOMER][NEUTRAL] It looks like it is still in.
[AGENT][NEUTRAL] Uh, yes, it looks like we, it looks like we received the, uh, I'm just checking to see when we got the claim itself. OK, so it looks like we received the claim on the [PII]. We processed it on the [PII].
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] of April. Now, the um policy does not cover.
[AGENT][NEUTRAL] The office visit
[AGENT][NEUTRAL] There was an $8.10 benefit.
[AGENT][NEUTRAL] That was paid on procedure.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Yes, uh-huh.
[CUSTOMER][NEUTRAL] Uh sorry, actually, it's so nice to hear your voice. Uh, I'm unable to hear your voice clearly.
[AGENT][NEUTRAL] Yeah, I know you've got a lot of background noise in there. I, yeah, I can hear a lot of, it's hard to hear you because it sounds like there's a lot of background noise. Um, the, uh, the claim was just processed on, on [PII], we got it on [PII]. We processed it on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Now the policy does not cover office visits.
[CUSTOMER][NEUTRAL] OK. The
[AGENT][NEUTRAL] But uh
[CUSTOMER][NEUTRAL] OK, continue, please. Sorry.
[AGENT][POSITIVE] But a benefit was paid.
[AGENT][NEUTRAL] On procedure code 82044.
[CUSTOMER][NEUTRAL] I
[AGENT][POSITIVE] But that benefit.
[AGENT][NEUTRAL] was paid
[AGENT][NEUTRAL] For this policy's $500 deductible.
[AGENT][NEUTRAL] So the
[AGENT][NEUTRAL] Procedure code 99214, that's the office visit.
[AGENT][NEGATIVE] is not covered for.
[AGENT][NEUTRAL] The insured's policy
[AGENT][NEUTRAL] Procedure code 82.
[CUSTOMER][NEUTRAL] So you are saying?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, so you are saying that the, the total amount is processed towards deductible, right?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have one more.
[CUSTOMER][NEUTRAL] Uh, date of service on the
[AGENT][NEUTRAL] OK, and what is that date of service please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] In the building?
[CUSTOMER][NEUTRAL] And the total bill amount is $207 and the remaining balance is $130.
[AGENT][NEUTRAL] OK, let me just check.
[CUSTOMER][NEUTRAL] 36 cents.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Si.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We
[AGENT][NEUTRAL] Claim number for this one here is 359.
[AGENT][NEUTRAL] 3633.
[AGENT][NEUTRAL] Now that particular claim.
[AGENT][NEUTRAL] It was received on the [PII]. It was also processed on the [PII], and the benefits went towards the deductible.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] So the entire, the office visit isn't covered and the benefit went towards the deductible.
[CUSTOMER][NEUTRAL] OK. It is also
[CUSTOMER][NEUTRAL] OK. Uh, total $130.86 is processed towards deductible, right?
[AGENT][NEUTRAL] Well, that it was it was $17.71 that the other benefits for the office visit wasn't covered.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] You're saying that the total amount is processed your deductible or it is insurance pay anything?
[AGENT][NEUTRAL] Uh, the, the insurance didn't pay anything. It, it went towards the deductible for this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, got it. Thank you. Uh, could you please spell your name?
[AGENT][NEUTRAL] Yes, it's [PII]
[AGENT][NEUTRAL] The first letter of my last name is [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] will be back in today's date for the record.
[AGENT][NEUTRAL] Is there anything else at all that
[CUSTOMER][POSITIVE] No, I got my information. What I need. Uh, it was nice talking to you. Have a great day. Bye-bye.
[AGENT][POSITIVE] Thanks for contacting the sales.