AccountId: 011433970860
ContactId: a173bfdf-a9b6-4245-84cd-8324e2a82924
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 535559 ms
Total Talk Time (AGENT): 143035 ms
Total Talk Time (CUSTOMER): 136911 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/a173bfdf-a9b6-4245-84cd-8324e2a82924_20250218T17:43_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, very good, good morning. This is [PII] calling from office to check on a claim status.
[AGENT][NEUTRAL] OK, sure, I can assist you with claim status. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] And how are you doing today? So?
[AGENT][POSITIVE] I'm good, thank you.
[CUSTOMER][NEUTRAL] Yeah. 02544684.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Let
[CUSTOMER][NEUTRAL] Hey.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] May I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, by age of [PII] with $1,478 even.
[AGENT][NEUTRAL] Can you repeat the date of service?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK. Thank you. Let me see if I can find this claim and for future, you can check claim status online through our website at [PII], and that's just optional. And you said the date of service is [PII], correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, um, let me pull this EOB one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I know.
[AGENT][NEUTRAL] What is the procedure code?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's 99204.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I, I don't have see uh our three CPDs for those who are [PII] also 76805.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, so this one was processed twice and the most recent one was processed and denied as a duplicate. So let me give you the original 11 moment.
[AGENT][NEUTRAL] OK. The original claim was processed [PII], and we send a benefit amount of $50 which is the maximum benefit for the date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] A benefit a motel, how much?
[AGENT][NEUTRAL] 15.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] $50 is the maximum benefit for data service.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] 6660, right? Uh 15.
[AGENT][NEUTRAL] 50, 50.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Maximum me right.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Do you need the claim number, [PII]?
[CUSTOMER][NEUTRAL] Give me a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] And may I know how much is the maximum amount? I mean, the total maximum amount?
[AGENT][NEUTRAL] $50 a day is the maximum benefit.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] In the theaters, right?
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] So, uh, it exceeds the limit, right, the benefit amount?
[AGENT][NEUTRAL] Yeah, I'm not understanding you, but $50 is the daily benefit amount. Um, so we did pay the $50 with that payment, the benefit has been exhausted for that date of service.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, that's why I exacer right. All right. Is there any patients responsibility?
[AGENT][POSITIVE] Mhm. Correct.
[AGENT][NEUTRAL] OK. Um, we are not a major medical, so any remaining balance is up to the provider's discretion.
[AGENT][NEUTRAL] This is just a limited policy. We're not a major medical.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Remaining, right, so remaining balance is the provider description, right?
[AGENT][NEUTRAL] Up to the provider's discretion, correct.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yeah, I'm there.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the allowed amount.
[AGENT][NEUTRAL] This is not a major medical. There's nothing allowed. There's nothing, uh, there's no co-payments, coinsurance, deductibles. This is not a major medical.
[CUSTOMER][NEGATIVE] Nothing allowed nothing allowed nothing copy. No, it's nothing in the copy.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And may I know the car reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you would like me, sir.
[CUSTOMER][POSITIVE] Um, yeah, sure, no problem. Uh thanks for your assistance. Have a great day. Bye-bye.
[AGENT][POSITIVE] You as well thank you for calling ATM. Bye bye sir.
[CUSTOMER][NEUTRAL] Bye-bye.