AccountId: 011433970860
ContactId: 5674babb-193e-4a35-9986-eda63f642908
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 502489 ms
Total Talk Time (AGENT): 114939 ms
Total Talk Time (CUSTOMER): 116438 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/5674babb-193e-4a35-9986-eda63f642908_20250121T13:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling you from provider's office, checking on general claim status.
[AGENT][NEUTRAL] I can help you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] Yeah, policy number is 016.
[CUSTOMER][NEUTRAL] 05184
[AGENT][NEUTRAL] Can I get phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, one moment please.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] What's the patient's name and date of birth, [PII]? Thank you for holding.
[CUSTOMER][NEUTRAL] Uh welcome. Yeah, the patient's first name is [PII] and the last name is [PII] Date of birth is [PII].
[AGENT][NEUTRAL] And you said that you're checking claim status?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, we can help you with that information. What's the date of service and total charge?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII]. total charge $412 even.
[AGENT][NEUTRAL] $4 412 dollars?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Still looking.
[AGENT][NEUTRAL] Alright, so the claim was received [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And I show it processed on [PII]. We're requesting a copy of the major medical explanation of benefits.
[CUSTOMER][NEUTRAL] OK, um, means you need primary EOB, am I right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Its primary EOB. OK. Uh, thank you. May I know which insurance is primary for this patient?
[AGENT][NEUTRAL] We show you HC but you would definitely need to confirm with your patient as well.
[CUSTOMER][NEUTRAL] OK, sure. Thank you. Same member, member has taken different service. Can you check for the date of service?
[AGENT][NEUTRAL] The date of service.
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII]. Total charge $273 even.
[AGENT][NEUTRAL] We need a copy of the primary explanation of benefits.
[CUSTOMER][NEUTRAL] OK. And when was the claim received on?
[AGENT][NEUTRAL] Did you have any other dates of service?
[CUSTOMER][NEUTRAL] Uh, no, not for this member. I more to claims, yeah, sure.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And you can also check your status on our online service center at [PII]. This claim was received [PII], processed on the [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. And can I get the claim number?
[AGENT][NEUTRAL] The claim number is 3542838.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sure. Yeah OK.
[AGENT][POSITIVE] And I, and I can help I can help you set that account up to check your statuses if you would like.
[CUSTOMER][NEUTRAL] Yeah, can you check for the next member?
[AGENT][NEUTRAL] OK, would you like to set up an online account to check your statuses?
[CUSTOMER][NEUTRAL] Uh, no, uh.
[CUSTOMER][NEUTRAL] I will try registering it.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, no, not for now.
[AGENT][NEUTRAL] OK, and the next policy number, um, this is the last one that I'm able to do.
[CUSTOMER][NEUTRAL] Sure. Yeah. The policy number is 02107421.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is [PII] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you and what's the date of service in charge?
[CUSTOMER][NEUTRAL] Yeah, date of service is [PII]. Total charge $865 even.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what are the procedure codes on the claim?
[CUSTOMER][NEUTRAL] 99204.
[CUSTOMER][NEUTRAL] 73,110.
[AGENT][NEUTRAL] OK, so the office visit is not covered under the patient's policy?
[AGENT][NEUTRAL] And the other code that's on the claim uh was paid in full by the primary. I'm showing the claim number is 3541295.
[AGENT][NEUTRAL] Received [PII], processed [PII].
[CUSTOMER][NEUTRAL] OK. And may I have your name spelled, please?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Your name spelled?
[AGENT][NEUTRAL] The spelling of my name, it's [PII], first initial and last name is [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, sure, yeah, it was great speaking with you. Have a good day. Bye bye.
[AGENT][POSITIVE] You're welcome, [PII], thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Bye.