AccountId: 011433970860
ContactId: 7cdbf953-6157-4c52-b15f-895c1a0f2116
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 243169 ms
Total Talk Time (AGENT): 78528 ms
Total Talk Time (CUSTOMER): 87007 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/7cdbf953-6157-4c52-b15f-895c1a0f2116_20250217T16:02_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling you from provider's office to check a claim.
[AGENT][NEUTRAL] OK. And you said your name was [PII]?
[CUSTOMER][NEUTRAL] Uh yeah.
[AGENT][NEUTRAL] OK, do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Yeah it's [PII].
[AGENT][NEUTRAL] That's a direct line.
[CUSTOMER][NEUTRAL] The extension is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And do you have a policy number?
[CUSTOMER][NEUTRAL] Yeah, I do have just a moment.
[CUSTOMER][NEUTRAL] 01817282
[AGENT][NEUTRAL] Thank you, hold on one moment, please.
[CUSTOMER][POSITIVE] Take your time, no worries.
[AGENT][NEUTRAL] And the patient's name?
[CUSTOMER][NEUTRAL] First name is [PII], last name is [PII]. The date of birth is [PII]. Sorry, yeah, it's [PII].
[AGENT][NEUTRAL] Hm
[AGENT][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] Thank you, [PII], and you were just needing benefit, I mean claim status, I'm sorry, claim status.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I can look that up for you. What data service.
[CUSTOMER][NEUTRAL] The date of service for this one is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what is the procedure code for that claim?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] There are two procedure codes which is 59285 and 93,010.
[AGENT][NEUTRAL] OK, we did get that claiming it was denied. They had met their maximum for the calendar year.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How many visits were allowed?
[AGENT][NEUTRAL] It's not a certain visit, they only get a certain amount per calendar year.
[CUSTOMER][NEUTRAL] OK. And when it was exceeded, means when it was completed, what is the last date of service?
[AGENT][NEUTRAL] They get
[AGENT][NEUTRAL] They get 4000 per calendar year and any benefits given over the phone is not a guarantee of payment. The
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It was made on [PII].
[CUSTOMER][NEUTRAL] Means onsite data of service.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] To do that
[CUSTOMER][NEUTRAL] You stated that uh means uh the provider build the same service or how it was paid.
[AGENT][NEUTRAL] It was, we paid the facility bill.
[CUSTOMER][NEUTRAL] Which facility?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] They had met their maximum on the facility bill.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'll pay with the card.
[AGENT][NEUTRAL] We do not have call reference numbers. You can use my name in today's date.
[CUSTOMER][POSITIVE] Sure, thank you for providing this information. Have a great day, [PII].
[AGENT][POSITIVE] Thank you, [PII], for calling APO. You have a good day as well.