AccountId: 011433970860
ContactId: 7bba4852-e17d-4b21-b9db-3c92c5ddee9e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 500380 ms
Total Talk Time (AGENT): 159887 ms
Total Talk Time (CUSTOMER): 117482 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/7bba4852-e17d-4b21-b9db-3c92c5ddee9e_20250317T18:37_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling for a doctor's office to check on our status.
[AGENT][NEUTRAL] I'm sorry, you're checking on claim status?
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] OK, and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] My phone number is [PII]. It's a direct line extension.
[AGENT][POSITIVE] Thank you very much. What is the policy number please [PII]?
[CUSTOMER][NEUTRAL] Yeah, policy number is H as in.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] No, I can see here the policy number is.
[CUSTOMER][NEUTRAL] 02512593.
[AGENT][NEUTRAL] OK, let me just repeat that to you. I have that as 02512593.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, member name is [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you very much, and you're calling for claim status. I can assist you, [PII]. You can also check claim status by visiting our secure portal at [PII], OK? And you're on that website you'll be able to obtain an EOB if you need one. What is that date of service and build amount total?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] There is that service is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the bill amount is
[AGENT][NEUTRAL] And the total charge is billed.
[CUSTOMER][NEUTRAL] Yes, it is $735 even.
[AGENT][POSITIVE] Thank you very much, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If you can verify the procedure codes that were bill for this service date for the member just to verify.
[CUSTOMER][NEUTRAL] Yeah, uh, civil procedure code 17681676825 and 81003.
[AGENT][NEUTRAL] I'm so sorry. I'm so sorry, [PII]. If you could slow down, I just want to verify I have the correct claim if you could repeat those procedure codes again, please.
[CUSTOMER][NEUTRAL] Yup. Uh, we will see CVD codes. The first CVV code is [PII].
[CUSTOMER][NEUTRAL] And the second one is [PII] and the third one is [PII].
[CUSTOMER][NEUTRAL] With the QW modifier.
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] One moment please.
[CUSTOMER][NEUTRAL] Oh right yeah so um.
[CUSTOMER][NEUTRAL] Please send a copy of your
[AGENT][NEUTRAL] OK one moment.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, excuse me, thank you. It shows that the claim was OK, received and we pay the maximum allowed amount of $50 for this date of service for those procedure codes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you need that claim number and check number? I can give that to you once you're ready for that.
[CUSTOMER][NEUTRAL] Uh, actually, I do have a uh specific concern on this claim. So we submitted, um, uh, we submitted an appeal with the medical records through fax on [PII]. So may I know the status of the app?
[AGENT][NEUTRAL] OK, so you're calling for a size and appeal. OK, one moment.
[AGENT][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, I'm gonna place you on a brief hold, OK? Thank you so much for the additional information. One moment, thank you.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Excuse me, [PII], are you there? OK, thank you. Just wanna make sure that you're still there. I'm still thank you. I'm still checking the status of that we did receive it, so I'm just trying to see what the.
[CUSTOMER][NEUTRAL] Yes, I'm here.
[AGENT][NEUTRAL] Response or the decision was if you would I'm gonna place you back on hold, OK? Sorry about that thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 8569465.
[AGENT][POSITIVE] OK [PII], thank you so much. I'm able to give that information to you now. It states that upon our reconsideration of Miss [PII]'s claim, it has been determined that the claim was processed correctly in accordance with the policy contract.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, when did you receive any bills from our end?
[AGENT][NEUTRAL] It was received on
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm OK.
[CUSTOMER][POSITIVE] OK, thank you very much, thank you for that.
[AGENT][NEUTRAL] You're welcome, [PII]. Anything else I can assist you with with this call?
[CUSTOMER][NEUTRAL] Uh yeah.
[CUSTOMER][NEUTRAL] Uh, could you please spell out your name for me?
[AGENT][NEUTRAL] My name is [PII], that's [PII]
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Can I have the call reference number for this call?
[AGENT][NEUTRAL] Um, we do not provide a reference numbers, [PII], however, please you can use my name and today's date, and my last initials [PII].
[AGENT][NEUTRAL] Anything else I can assist you with, please?
[CUSTOMER][POSITIVE] No, I'm done. Thank you very much. Thank you for that information and spending your valuable time. Have a great day.
[AGENT][NEUTRAL] Excuse me.
[AGENT][POSITIVE] Thank you for calling APL method. You as well bye bye. Thank you.