AccountId: 011433970860
ContactId: 9e1b99c1-7046-4947-ae90-28dfb83f9f9c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 189529 ms
Total Talk Time (AGENT): 86537 ms
Total Talk Time (CUSTOMER): 80526 ms
Interruptions: 0
Overall Sentiment: AGENT=2.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/9e1b99c1-7046-4947-ae90-28dfb83f9f9c_20250131T17:52_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi. Uh, my name is [PII] and I'm calling you from provider's office on-demand urgent care group, and I need your help regarding a claim.
[AGENT][POSITIVE] Well it would be my pleasure to assist you with that claim information, [PII]. What is a good callback number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And do you have the claim number or the patient's policy number?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, I do have the claim number.
[CUSTOMER][NEUTRAL] And the claim number is 353-433-3.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, the patient name is uh [PII].
[CUSTOMER][NEUTRAL] And uh the date of birth is [PII].
[AGENT][NEUTRAL] Alright thank you and do you mind verifying the date of service bill amount and provider name?
[CUSTOMER][NEUTRAL] Oh man.
[CUSTOMER][NEUTRAL] Yeah, the data service is uh [PII] and bill amount is $280 and the provider name is On Demand Urgent Care Group.
[AGENT][NEUTRAL] All right, thank you. And I can help you with that claim information, [PII]. I do have that claim pulled up.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] What is your concern with this claim, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, actually, the claim is paid for the CT 99203 for $75 and the CT 87,880 was denied, so I just want to know the denial reason for the City.
[AGENT][POSITIVE] It would be my pleasure to assist you with this policy per the policy guidelines of the patient's plan, the maximum we can pay for that per date is $75.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] So they did pay it on the 99203 and then the 87,880 was denied as the maximum benefit met for that data service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So, uh, which type of a plan the member have?
[AGENT][NEUTRAL] It's a limited hospital indemnity policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, not an issue, and
[CUSTOMER][NEUTRAL] Yup, I'm done for now. Can you please uh confirm me your name?
[AGENT][POSITIVE] My name is [PII]. And it was a pleasure to assist you with that claim information, [PII]. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Yeah, uh, and is there any reference number?
[AGENT][NEUTRAL] The reference number would be my name and today's date, and I spell my name [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] My pleasure.
[CUSTOMER][POSITIVE] Yup, I'm done for now. Have a good day. Goodbye.
[AGENT][POSITIVE] And thank you for calling APL. I hope you have a wonderful day as well, [PII]. Take care.