AccountId: 011433970860
ContactId: 8773156a-de32-4f62-b740-9885da4506c8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 347929 ms
Total Talk Time (AGENT): 83431 ms
Total Talk Time (CUSTOMER): 147839 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/8773156a-de32-4f62-b740-9885da4506c8_20250127T20:58_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, this is [PII] calling from provider's office to check up on a claim status. Also, this call has been recorded for quality and training purposes. Are you OK with that?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] You said your name is [PII]?
[CUSTOMER][NEUTRAL] It's [PII] spelled as [PII] my [PII].
[AGENT][NEUTRAL] Give me that
[AGENT][NEUTRAL] Give me that one more time please.
[CUSTOMER][NEUTRAL] It's [PII] spelled as [PII]. Initial of my last name is [PII]. Also, can you spell out your name for me?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And [PII], we can assist you. What's the claim the policy number?
[CUSTOMER][NEUTRAL] Uh, sure, just give me a moment.
[CUSTOMER][NEUTRAL] Policy number would be 01.
[CUSTOMER][NEUTRAL] 988281 M as in Mike L as in Lima 8.
[AGENT][POSITIVE] Thank you and a phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it would be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK. And um what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name would be [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thanks for that information. And is your name pronounced [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK, what's the we're checking claim status correct?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh yeah, actually I do have specific concern with the claim.
[AGENT][NEUTRAL] So do you have the claim number?
[CUSTOMER][NEUTRAL] Yeah, I do have.
[AGENT][NEUTRAL] OK, and that number?
[CUSTOMER][NEUTRAL] The claim number would be 351-6484.
[AGENT][NEUTRAL] And your question regarding on that claim?
[CUSTOMER][NEUTRAL] Actually there are uh on this claim there are two procedure codes which is 76,830 and 76856.
[CUSTOMER][NEUTRAL] But you have paid only for 76,830.
[CUSTOMER][NEUTRAL] For 116.70, yeah.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I just need to know what about the other procedure code.
[AGENT][NEUTRAL] You have a copy of the explanation of benefits in front of you?
[CUSTOMER][NEUTRAL] A of
[CUSTOMER][NEUTRAL] OK. You mean to say you need a primary EOB for the, for the processing.
[AGENT][NEUTRAL] No. Yeah, I was just asking, did you receive the explanation of benefits with the check that you received from APL?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Turn to the back of the ELD and it'll give you the remark code.
[CUSTOMER][NEGATIVE] But actually there there is no remark because I didn't found any that's why.
[CUSTOMER][NEUTRAL] I found remarks 1 or 2, but there is no specific reason mentioned on that EOB.
[AGENT][NEUTRAL] It says the maximum benefit payable for this date of service has been met, so that was what was available available for that date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and uh like.
[CUSTOMER][NEGATIVE] How it's been denied as maximum benefit like in dollar value and visit its value.
[AGENT][NEUTRAL] Dollar dollar.
[CUSTOMER][NEUTRAL] Dollars. OK.
[CUSTOMER][NEUTRAL] And you can pay how much dollars for the.
[AGENT][NEUTRAL] The maximum benefit per calendar day is 500, so the remaining for that calendar day is what was paid on your claim.
[CUSTOMER][NEUTRAL] OK, OK, sure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just give me a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK, sure, thank you so much.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] Uh, no, can you help me with the call reference number?
[AGENT][NEUTRAL] Mhm. You'll use my name in today's date as your reference, [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And first initial last name is [PII].
[CUSTOMER][POSITIVE] Thank you so much, [PII], for your help. That's it for the day.
[AGENT][POSITIVE] You're welcome. You're welcome, [PII]. Thank you for calling APL. If you have questions, have a good day.
[CUSTOMER][POSITIVE] Have a great day bye bye take care.
[AGENT][NEUTRAL] Bye-bye.