AccountId: 011433970860
ContactId: 88790bc0-96ed-4dde-a4bf-13673ff225a5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 384149 ms
Total Talk Time (AGENT): 116469 ms
Total Talk Time (CUSTOMER): 161258 ms
Interruptions: 5
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/88790bc0-96ed-4dde-a4bf-13673ff225a5_20250421T16:15_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hello, this is [PII]. I'm calling from the broadest office to check on a claims.
[AGENT][NEUTRAL] OK, [PII], do you have a phone number I can get in case we get disconnected I can call you back.
[CUSTOMER][NEUTRAL] [PII] is a direct line.
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] D as in Delta. OK, I have the policy number. Give me a moment.
[CUSTOMER][NEUTRAL] The policy number I have 02571782.
[AGENT][NEUTRAL] Thank you, [PII]. Hold on one moment, please.
[AGENT][NEUTRAL] And what's that patient's name?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] So, it is [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And you were needing claim status?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I can help you with that. What's the date of service?
[CUSTOMER][NEUTRAL] It is [PII] for charge $707 and even.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Pardon?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] I don't.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] or
[CUSTOMER][NEUTRAL] Meanwhile, could you spell your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] We did receive that claim. We paid $100 on it.
[CUSTOMER][NEUTRAL] OK. When did you receive this one?
[AGENT][NEUTRAL] Hold on just a moment and I can tell you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 3 24 25.
[CUSTOMER][NEUTRAL] And do you have the process date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, how much it allowed?
[AGENT][NEUTRAL] $100 is what we paid.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. So no patient responsibility.
[AGENT][NEUTRAL] Whatever is left over would be patient's responsibility. We paid the $100 that the policy allowed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] All right. And the both codes are paid, right? 99204 and 87428?
[AGENT][NEGATIVE] We paid the 99204 and the 87428 was denied as max met because all we pay on an office visit is $100 per office visit, 4 times per calendar year.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 4 times per calendar year and this is the 5th time so it's exceed already.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No, we paid the $100 on the office visit. It doesn't matter what they have done in that doctor's office visit, we only pay $100 for the whole visit.
[CUSTOMER][NEUTRAL] You that
[AGENT][NEUTRAL] So we paid that one.
[CUSTOMER][NEUTRAL] OK, I understand. Uh, OK, and what is the claim number?
[AGENT][NEUTRAL] 3581253.
[CUSTOMER][NEUTRAL] 3581253, OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, and payment run through check or EFT.
[AGENT][NEUTRAL] Check
[CUSTOMER][NEUTRAL] What is the check number?
[AGENT][NEUTRAL] 2035401.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's a bulk or single?
[AGENT][NEUTRAL] Single, we do not issue book checks.
[CUSTOMER][NEUTRAL] And it is issued on [PII], right? Do you have a clear date?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] That's when it was paid 326.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] On [PII] is cleared on the same day.
[AGENT][NEUTRAL] Oh, we did, uh, you wanted to know when it was cleared?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] It's still outstanding.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And cannot be reissued to 426.
[CUSTOMER][NEUTRAL] To.
[CUSTOMER][NEUTRAL] All right. It's still outstanding. And uh what is the pay to address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] 33. All right. OK.
[CUSTOMER][NEUTRAL] OK, I need a call reference number.
[AGENT][NEUTRAL] We do not have call reference numbers. You can use my name in today's date.
[CUSTOMER][POSITIVE] All right. OK, that's all then. Thank you. I appreciate that.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.