AccountId: 011433970860
ContactId: 9c0dda1d-4f07-425b-9f12-8f09558414ab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 314690 ms
Total Talk Time (AGENT): 94247 ms
Total Talk Time (CUSTOMER): 223448 ms
Interruptions: 10
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/9c0dda1d-4f07-425b-9f12-8f09558414ab_20250306T13:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, good morning. My name is [PII]. I'm calling from the office looking for a claim status.
[AGENT][NEUTRAL] OK, I can help you with the claim status. Spell your name for me please.
[CUSTOMER][NEUTRAL] Yes, spelled like [PII]. Yeah, just a moment.
[AGENT][NEUTRAL] OK, [PII], thank you. And do you have the policy number?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yeah, the policy number is uh
[CUSTOMER][NEUTRAL] Yeah, it's 02448572.
[AGENT][NEUTRAL] 48572.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, my good callback number is [PII] direct line.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the member name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for verifying that information and we're checking claim status for what date of service?
[CUSTOMER][NEUTRAL] Yeah, the date of [PII].
[AGENT][NEUTRAL] And the build amount.
[CUSTOMER][NEUTRAL] And the bill, yeah, the bill amount is total bill amount is $1,895 even, but the technically claim was split in two parts and the, the first amount is $1,295 and the second one is $600. Yes, one separate claim, but the claim was split in two parts.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So were all of the codes filled on one claim or two separate claims?
[AGENT][NEUTRAL] OK, what are the procedure codes on the claim?
[CUSTOMER][NEUTRAL] Yeah, just a moment. There's just 1010 procedure code.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Just give me about 3 of them.
[CUSTOMER][NEUTRAL] Uh. Yeah, it's uh [PII].
[CUSTOMER][NEUTRAL] 80061.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the provider's name?
[CUSTOMER][NEUTRAL] Yeah, just a moment.
[CUSTOMER][NEUTRAL] Yeah, the rendering provider name is
[CUSTOMER][NEUTRAL] Gisela Ornets.
[AGENT][NEUTRAL] This is North Shore Hematology oncology? OK.
[CUSTOMER][NEUTRAL] Yeah, it's a, yeah, it's a facility name is North Hamda Lodge oncology.
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][POSITIVE] Thank you for calling.
[AGENT][NEUTRAL] OK, so there was no payment made on this claim. It says that the calendar year maximum for outpatient office visits due to a sickness and or accident has been met for this calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. Oh, do you receive any claim for this number? Yeah, can you please repeat again?
[AGENT][NEUTRAL] Yes, and I just gave you the status of that claim.
[CUSTOMER][NEUTRAL] Yeah, I'm a IV 88819-119.
[AGENT][NEUTRAL] Can you hear me OK?
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] The claim received date is [PII].
[AGENT][NEUTRAL] The process date is [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No payment was made on this claim because the maximum office visits have been used. The claim number is 351.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 2181.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, you, uh, and you did not, it's the maximum use CD code I'm right?
[AGENT][NEUTRAL] Yeah, the maximum visits.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The maximum office visits per calendar year are exhausted.
[CUSTOMER][NEUTRAL] Uh, yeah, it's not count under the member plan or the provider plan.
[AGENT][NEUTRAL] It's gonna be the patient's policy.
[CUSTOMER][NEUTRAL] Oh, on the member plan, I'm right?
[AGENT][NEUTRAL] The patient's policy, yes.
[CUSTOMER][NEUTRAL] Oh, OK. And um
[CUSTOMER][NEUTRAL] Just a moment. Yeah, and uh may I know your name and last name, sir?
[AGENT][NEUTRAL] You'll use my name in today's date as reference for today's call. [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] [PII], first initial last name is [PII]. Any other questions I can help with today, [PII]?
[CUSTOMER][POSITIVE] No, thank you for assisting me, dear. Have a good day.
[AGENT][POSITIVE] You too have a good day thanks for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.