AccountId: 011433970860
ContactId: 8f564005-4f85-43f0-b264-9cb171d35caf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 642900 ms
Total Talk Time (AGENT): 228145 ms
Total Talk Time (CUSTOMER): 272512 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/8f564005-4f85-43f0-b264-9cb171d35caf_20250317T16:45_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, my name is [PII], and you should go first trial likeroy calling from provider office. How are you today?
[AGENT][POSITIVE] I'm good, thank you. How about you?
[CUSTOMER][POSITIVE] I'm good, good, and thanks for asking. Actually, the reason of the call, I need information about the claims that are regarding some claims. Can you assist me today?
[AGENT][NEUTRAL] OK, sure. I can assist you with claims and let me have the spelling of your name.
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] OK, and a callback number just in case we get disconnected, Mr. [PII].
[CUSTOMER][NEUTRAL] Sure. It's uh it's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] then [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Sure. It's 02.
[CUSTOMER][NEUTRAL] 564,460.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh, patient name is uh [PII], and her date of birth is [PII].
[AGENT][POSITIVE] OK, perfect. Thank you.
[AGENT][NEUTRAL] And what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] OK. So, it's a medical claim and the date is going to be [PII], 11-11, [PII], where the bill amount is $675 675 dollars.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Let me see if I can find this claim for you and for future, you can check claim status online through our website at [PII] and that's just optional.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so much for that information.
[AGENT][NEUTRAL] You're welcome. OK. And you said the total charge is 6,075 or 675?
[CUSTOMER][NEUTRAL] It's $675.
[AGENT][NEUTRAL] 6
[AGENT][NEUTRAL] OK thank you. One moment, let me see if I can find this claim. And uh do you have a procedure code by any chance?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm, yes, I do. The post code which was billed in that claim, it's 93351.
[AGENT][NEUTRAL] OK, here it is.
[AGENT][NEUTRAL] It looks like we processed the claim on [PII].
[AGENT][NEUTRAL] And we send a benefit amount of $497.46 to the provider.
[CUSTOMER][NEUTRAL] OK. Uh, are you paid?
[AGENT][NEUTRAL] Yes, we send a benefit a payment amount of $497.46.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] OK. Can you provide me the claim number?
[AGENT][NEUTRAL] Yes, the claim number is 3572612.
[CUSTOMER][POSITIVE] All right. Thank you so much for that information. Can you provide me the check number?
[AGENT][NEUTRAL] Check number is 2031633.
[CUSTOMER][NEUTRAL] OK. It's for payment posting purpose, for confirmation, it's uh 2031633, correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. What's the check issue date?
[AGENT][NEUTRAL] The same as the process date, [PII].
[CUSTOMER][POSITIVE] OK. Thank you so much for that information. I have 2 more claims for the same patient uh with same facility, OK?
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] OK, and what is the next date of service?
[CUSTOMER][NEUTRAL] Just give me one moment here. I pulled up the next claim for that one patient.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] So, the next date of service is going to be
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And with the bulk amount is $510.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, let me pull this one.
[CUSTOMER][POSITIVE] Take your time.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] OK, no problem. Take your time.
[AGENT][POSITIVE] Mhm. Thank you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It.
[CUSTOMER][NEUTRAL] Uh, 260 bulk in that claim 99204 and 9300.
[AGENT][NEUTRAL] OK, thank you. All right, yes, I found it, and this one was processed on the same date, [PII]. We send a benefit amount of $31.78. This is for the procedure code of 93,000. And the procedure code 99204 was not paid because office visits are not covered by this policy.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK. So offices is not pay uh not covered in that uh that policy. So how much are you paid? How much are you paid? Mm mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 31.
[AGENT][NEUTRAL] We paid $31.78 for the procedure 93,000.
[CUSTOMER][POSITIVE] OK. Thank you so much for that information. Uh, is the check number the same as previous?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] No, it's a different one. It's this, uh, they're all gonna be single checks, paper checks. Um, so for the 3178, the check number is 203.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 162 3.
[CUSTOMER][NEUTRAL] OK. It's 2031623. What's the claim number?
[AGENT][NEUTRAL] The claim number is
[AGENT][NEUTRAL] 3572608.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] All right. Thank you so much for that information. And the check date for that one specific claim for 31 and 78 uh is uh same as processes, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm, right.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][NEUTRAL] Mm
[CUSTOMER][POSITIVE] I really appreciate that.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Uh, can you repeat the check number for, uh, uh, for 3178. I mixed up for with previous, uh, I really apologize for that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's OK, no problem. All right, uh, the check number is 2031623.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Uh, thank you so much.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK. And the office is not paid under that plan, correct? Not covered.
[AGENT][POSITIVE] Correct. I know the patient's plan, correct. Mhm.
[CUSTOMER][NEUTRAL] OK. Should, uh, and, and should we bill the patient for that amount?
[AGENT][NEUTRAL] It's up to the provider's discretion. We don't have any contractual involvement in the remaining of the claim.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, for, OK. Give me one moment for the last one claim for same patient. Just give me one moment. And
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, the next one date of service is going to be
[CUSTOMER][NEUTRAL] Uh [PII], [PII], uh, with the bill amount is $200.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right.
[AGENT][NEGATIVE] OK, so this one was processed the same date, [PII]. Now, this one was denied because it's an office visit and office visits are not covered by the policy.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you provide me the claim number?
[AGENT][NEUTRAL] Yes, the claim number on this one is 3,572,610.
[CUSTOMER][POSITIVE] OK. 3,572,610. Perfect. So,
[CUSTOMER][POSITIVE] Thank you so much for that information. And then I really appreciate that your assistance. Can you provide me uh the call reference number, hold, hold the call?
[AGENT][NEUTRAL] We don't have reference numbers, so you can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] Uh, OK. So, uh, what's your name?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much for that. Uh, I have no more calling for today and I really appreciate your assistance. Have a nice day. Take care. God bless you, ma. Bye for now.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] You as well. Thank you for calling ATM. You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But is any, uh any survey idea?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, no, we don't have a survey.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK. OK. Bye.
[AGENT][POSITIVE] Have a good day. Mm bye-bye.