AccountId: 011433970860
ContactId: 9b7d58a9-6d06-44f6-903d-1e53487dfc9b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 156729 ms
Total Talk Time (AGENT): 78566 ms
Total Talk Time (CUSTOMER): 42430 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/9b7d58a9-6d06-44f6-903d-1e53487dfc9b_20250115T21:33_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes [PII], I'm checking on claim status for a patient.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the claim status, and may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII]. It's [PII].
[AGENT][NEUTRAL] Thank you for that. [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I have 02389034.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have, well, is there multiple date of service?
[CUSTOMER][NEUTRAL] One
[AGENT][NEUTRAL] OK. Um, may I have the date of service and the total bills?
[CUSTOMER][NEUTRAL] [PII] total charges 344, your secondary to community care.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] 344.
[AGENT][NEUTRAL] And what would be the name of the provider's office on the claim?
[CUSTOMER][NEUTRAL] Metro Tulsa Foot and ankle specialist Dr. [PII].
[AGENT][NEUTRAL] OK, this is it. Thank you for that. So I'm showing that we received the claim.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] That claim number is 354.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] 8144.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And on [PII], the claim was denied.
[AGENT][NEUTRAL] Um, code 99203.
[AGENT][NEGATIVE] was denied because office visits are not covered on the policy. And let me see the other one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then 73,630 was denied because the outpatient benefit for the calendar year has been met.
[CUSTOMER][NEUTRAL] OK, so, um, can I get a reference number, [PII]?
[AGENT][NEUTRAL] Sure, there's no call reference number, but you can use my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you [PII] have a great day.
[AGENT][POSITIVE] You also [PII], and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm bye bye.