AccountId: 011433970860
ContactId: 7f015eb8-7253-469c-aabe-c55532275b5a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 323959 ms
Total Talk Time (AGENT): 96790 ms
Total Talk Time (CUSTOMER): 111486 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/7f015eb8-7253-469c-aabe-c55532275b5a_20250131T19:26_UTC.wav
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[AGENT][POSITIVE] Good Afternoon. Thanks for calling AK this [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, um, I am calling because I have a question about a secondary claim that was submitted to you guys, um, along with a couple others, and the others got paid, but this one didn't get paid when it was expecting to, so I was just calling to see if I could get an explanation on that.
[AGENT][POSITIVE] OK, I can help you with that. Can I get a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] Policy number is
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] That's the um group number. It will be the certificate number.
[CUSTOMER][NEUTRAL] OK, um, 02454148 M as in Mary L 8.
[AGENT][NEUTRAL] Can I get your name please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your last name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, and are you the um provider or are you um
[AGENT][NEUTRAL] Calling for the policyholder.
[CUSTOMER][NEUTRAL] Uh, the provider.
[AGENT][NEUTRAL] OK, and um, can you verify the member's name, date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII], [PII].
[AGENT][NEUTRAL] OK, [PII], thank you for that. And you said you had a question about one of the claims that wasn't processed?
[CUSTOMER][NEUTRAL] Yes, so, um, we.
[CUSTOMER][NEUTRAL] Had billed three claims at once and the other two came back what we were expecting to get paid but the date of service 5/20 through [PII] um it paid less than expected so I was just calling to see um.
[CUSTOMER][NEUTRAL] I can't see an explanation of benefits or anything so I was just calling to see if there was any um remark or anything on the claim on your end.
[AGENT][NEUTRAL] Do you have a claim number?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Let me see if I can find one.
[AGENT][NEUTRAL] It would start with a 3.
[CUSTOMER][NEUTRAL] A 3? OK.
[CUSTOMER][NEUTRAL] Sorry, my computer is being slow today.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I
[CUSTOMER][NEUTRAL] Oh, here we go, OK.
[CUSTOMER][NEUTRAL] I don't have a claim number now.
[AGENT][NEUTRAL] OK, is it for 5/20 of 24?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] And what type of service was this for?
[CUSTOMER][NEUTRAL] Uh, this would be physical therapy.
[AGENT][NEUTRAL] OK, and just for future reference providers do have access to check claim status on our website, which is at [PII].
[AGENT][NEUTRAL] So, um, let me pull up the actual claim and I can look at the EOB.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So it looks like we paid out $65 on the code 97161, um, as far as the code 97,110.
[AGENT][NEUTRAL] Um, we were not able to pay that because according to the primary EOB, let me see.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh 5:20.
[AGENT][NEUTRAL] So for data service of [PII], 97,110 on the EOB there's nothing due, so we, because we only pick up co-pay coinsurance deductible.
[AGENT][NEUTRAL] So there was nothing due on you will be for that data service and procedure code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, all right, thank you very much. Am I able to have a reference number for this?
[AGENT][NEUTRAL] We don't give reference numbers. You can use my name in today's date.
[CUSTOMER][NEUTRAL] OK, can I have your name again? I'm sorry.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] All right thank you very much.
[AGENT][POSITIVE] No problem, [PII]. Was there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] No ma'am, that's all.
[AGENT][POSITIVE] Alright, thanks for calling A you have a wonderful day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][NEUTRAL] Um bye.
[CUSTOMER][NEUTRAL] OK.