AccountId: 011433970860
ContactId: 68289a19-9c5b-44b3-a33b-ad41796bb464
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 169139 ms
Total Talk Time (AGENT): 87275 ms
Total Talk Time (CUSTOMER): 57897 ms
Interruptions: 1
Overall Sentiment: AGENT=2.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/68289a19-9c5b-44b3-a33b-ad41796bb464_20250320T16:14_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, yes, ma'am, I was calling to check on claim status.
[AGENT][POSITIVE] It would be my pleasure to assist you with claim status. What is your name, please?
[CUSTOMER][NEUTRAL] Um, my name is [PII].
[AGENT][POSITIVE] Thank you, [PII], and a callback number, please?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] And [PII], what is the policy number for the patient?
[CUSTOMER][NEUTRAL] It is let's see.
[CUSTOMER][NEUTRAL] 01640969
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Um, it's [PII] and it's [PII].
[AGENT][NEUTRAL] Alright thank you and I can help you with that claim status. What is the data service?
[CUSTOMER][NEUTRAL] It is 12:31 2024.
[AGENT][NEUTRAL] In the build amount.
[CUSTOMER][NEUTRAL] It is $270.
[AGENT][NEUTRAL] Thank you and what is the facility name?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mm, so I'm not sure which one it would be under, but maybe Medical Associates plus or may OK.
[AGENT][POSITIVE] Perfect, perfect. That's it. Yes, ma'am.
[CUSTOMER][NEUTRAL] Sorry, there's like two different, OK.
[AGENT][POSITIVE] Not a problem at all. I've got that claim pulled up. We did receive the claim for Fay on [PII] I'm sorry, 224-25.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim was processed on 226-25.
[AGENT][NEGATIVE] The 99203 was denied.
[AGENT][NEUTRAL] As office visits are not covered under the patient's plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the CPT 11 721 was denied.
[AGENT][NEUTRAL] As benefits are only payable if the major medical provides benefits.
[AGENT][NEUTRAL] So we only pay toward the deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And according to that EOB nothing was applied.
[CUSTOMER][NEUTRAL] OK, so, so nothing was paid towards it?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK alright thank you so much.
[AGENT][NEUTRAL] Would you like that claim number?
[CUSTOMER][NEUTRAL] Uh, sure.
[AGENT][NEUTRAL] Claim number is 356.
[AGENT][NEUTRAL] 867 9.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, alright, thank you.
[AGENT][POSITIVE] My pleasure to help you with that claim status, [PII]. Anything else I can help you with before you go?
[CUSTOMER][NEUTRAL] Uh, no, ma'am, that's it.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] And thank you for calling APL. Hope you have a wonderful day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Thank you. Bye-bye.