AccountId: 011433970860
ContactId: 8bebc042-0318-49f4-8e85-1a2a62a745e7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 158679 ms
Total Talk Time (AGENT): 79237 ms
Total Talk Time (CUSTOMER): 46091 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/8bebc042-0318-49f4-8e85-1a2a62a745e7_20250226T19:21_UTC.wav
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[AGENT][NEUTRAL] Calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from Retina Group of [PII], and I was calling in regards to check the claim status.
[AGENT][NEUTRAL] Sure, I can assist you with that. Can I have your callback number, Ira?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what is the policy number of the member that you're inquiring claim status for today?
[CUSTOMER][NEUTRAL] 02323260
[AGENT][NEUTRAL] I do apologize. Could you repeat that policy number, Ira?
[CUSTOMER][NEUTRAL] 02323260
[AGENT][NEUTRAL] Could you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you're calling to check the status of the claim for what date of service for [PII].
[CUSTOMER][NEUTRAL] Um [PII].
[AGENT][NEUTRAL] And what is your procedure code?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 92004.
[AGENT][NEUTRAL] Uh
[AGENT][POSITIVE] 0897 thank you.
[AGENT][NEUTRAL] This claim was received [PII]. It was processed [PII]. There was a payment of $25 made on this claim. What were your concerns about it?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So they didn't pay the rest because of the deductible?
[AGENT][NEUTRAL] No, we didn't pay the rest because the mem the maximum had been met. The member's policy only pays $25 per office visit up to $25 per visit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is not a guaranteed benefit, yes, just a disclaimer on the policies coverage, just a maximum of $25.
[CUSTOMER][NEUTRAL] Maximum is 2.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, is there a claim number?
[AGENT][NEUTRAL] It's 343-089-97.
[AGENT][NEUTRAL] And Ira, could you spell your name for me? Is it [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Is there a call reference number?
[AGENT][NEUTRAL] We don't provide those unfortunately, however, you can use my name in today's date as a reference.
[CUSTOMER][NEUTRAL] OK, how do you spell your name?
[AGENT][NEUTRAL] [PII], and today's date.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too, bye.
[AGENT][POSITIVE] Thanks. Goodbye.