AccountId: 011433970860
ContactId: 4a20299c-dc5d-46cd-a435-320079be914e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 403260 ms
Total Talk Time (AGENT): 122911 ms
Total Talk Time (CUSTOMER): 159890 ms
Interruptions: 5
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/4a20299c-dc5d-46cd-a435-320079be914e_20250130T15:39_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Let's see how can I help you
[CUSTOMER][NEUTRAL] Hi, I'm [PII] calling on behalf of office. By the way, how are you doing today?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, I'm good as well. Thanks for asking.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Yeah, can I get a good call back number?
[CUSTOMER][NEUTRAL] Yes, my callback number is [PII] with the [PII] [PII].
[AGENT][NEUTRAL] OK, thank you [PII]. Can I get the policy number?
[CUSTOMER][NEUTRAL] OK, thank you. There's the policy number?
[CUSTOMER][NEUTRAL] 021-91897.
[AGENT][NEUTRAL] OK, thank you [PII] can you confirm the insured's name and date of birth for me?
[CUSTOMER][POSITIVE] OK thank you
[CUSTOMER][NEUTRAL] Has the
[CUSTOMER][NEUTRAL] Insured's name is [PII].
[CUSTOMER][NEUTRAL] Goose and uh diabetes, [PII].
[AGENT][NEUTRAL] OK, thank you and [PII] are you calling to check on claim status?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I can definitely take a look. What's that data service and build amount?
[CUSTOMER][POSITIVE] OK, definitely.
[CUSTOMER][NEUTRAL] Yes, the data services [PII] and the bill amount is $90.59.
[AGENT][NEUTRAL] OK, you said [PII]?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] No, the date of services?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let's see here.
[CUSTOMER][NEUTRAL] Let's see here.
[AGENT][NEUTRAL] OK, so it looks like we received this claim twice.
[CUSTOMER][NEUTRAL] OK, so.
[AGENT][NEUTRAL] So give me just a second.
[CUSTOMER][POSITIVE] No problem. You take your time. No issues. I'm always waiting for your response.
[AGENT][NEUTRAL] OK, so I do have the original claim number for you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The original claim number is 3502273.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] It was received on [PII], processed on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 62 received on [PII].
[AGENT][NEUTRAL] It was received on [PII] and it processed on [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it denied as the calendar year maximum for outpatient office visits due to sickness or accidents has been met for the calendar year.
[CUSTOMER][NEUTRAL] And I'm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] The 2nd time we received the claim, I have that claim number for you as well.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That claim number is 35398005.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It was received on [PII], processed on [PII].
[CUSTOMER][NEUTRAL] It.
[AGENT][NEGATIVE] And it denied as a duplicate.
[CUSTOMER][NEUTRAL] I want to verify the, I send the uh electronic payer ID.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] 60801. Is it correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] How
[CUSTOMER][NEUTRAL] May I place your call on hold one minute?
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thanks for being on hold. I really appreciate your patience.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] May I know the
[CUSTOMER][NEUTRAL] The current CPT maximum visit time.
[AGENT][NEUTRAL] They're allowed 6 visits per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 6 time only, uh?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Uh, for 99292 CBDs only to allow for yearly or 6 times, is it correct?
[AGENT][NEUTRAL] They're allowed 6 office visits per calendar year.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, thank you. May I know your name, please? Could you please spell your name?
[AGENT][NEUTRAL] It, it's [PII] and that's actually gonna be the call reference number, so it'd be [PII] with the 1st 1st initial to my last name [PII], and today's date. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Is there anything I can help you?
[CUSTOMER][NEUTRAL] Your name is [PII]. Is that correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Your call reference number is your name and today's date.
[AGENT][POSITIVE] Yes sir, that's correct.
[CUSTOMER][NEUTRAL] OK, [PII], uh, your name spell is [PII]. Is it correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you. Thank you so much for your wonderful lessons. Have a great day.
[AGENT][POSITIVE] OK, well thank you alright well thank you for calling APL you do the same bye bye.
[CUSTOMER][NEUTRAL] Me too. Bye-bye.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] Bye. Thank you.