AccountId: 011433970860
ContactId: 4e7e7f44-b6ae-4f26-a42a-7eb752a85b5b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 218800 ms
Total Talk Time (AGENT): 59586 ms
Total Talk Time (CUSTOMER): 69289 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/4e7e7f44-b6ae-4f26-a42a-7eb752a85b5b_20250414T14:16_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh yeah, I'm trying to get some information on the claim that we submitted.
[AGENT][NEUTRAL] OK, I can help you with claim status. Could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Sure, it's [PII] and the phone number is [PII].
[AGENT][NEUTRAL] Hi, [PII], do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Um, I have an ID number.
[AGENT][NEUTRAL] OK, that's it.
[CUSTOMER][NEUTRAL] D as in David, 43731312.
[AGENT][NEUTRAL] And do you have the patient last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] Uh, this is [PII].
[AGENT][NEUTRAL] The [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let's see
[AGENT][NEUTRAL] Is this for um medical or dental?
[CUSTOMER][NEUTRAL] Uh, medical.
[AGENT][NEUTRAL] And what was that date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you're just seeing the status of it, is that correct?
[CUSTOMER][NEUTRAL] Well, yeah, it looks like we got partial um.
[CUSTOMER][NEUTRAL] Partial claim back, but I'm not sure if the other half of it's still processing or what the status of it is.
[AGENT][NEUTRAL] Um, so the patients on a limited hospital indemnity plan, so it does have very limited benefits for this state of service. They just have a maximum payout of $75 for an office visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, got it. OK. So the rest would be sent to PR?
[AGENT][NEUTRAL] Um, so we don't determine patient responsibility since this is a supplemental policy. We just simply process the claim um according to their plan.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So you don't necessarily deny the other CPT codes, you just apply $75 and that's it.
[AGENT][NEUTRAL] Well, we, we did deny the other codes as non-covered, um, because it just met the maximum payout, so yes, it will reflect that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. OK.
[CUSTOMER][NEUTRAL] OK, on the EOB it's just blank so I didn't have any remarks or anything that it was denied or whatnot so.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, that's what I need to know. If I could just get a reference number for our call today.
[AGENT][NEUTRAL] Um, it's just my name and today's date.
[CUSTOMER][NEUTRAL] OK, and what was your name?
[AGENT][NEUTRAL] [PII],
[CUSTOMER][NEUTRAL] 7, OK.
[CUSTOMER][POSITIVE] Thank you so much for your help.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.