AccountId: 011433970860
ContactId: b320a70e-54f0-4628-89ba-4339e3fe1aad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 361880 ms
Total Talk Time (AGENT): 110736 ms
Total Talk Time (CUSTOMER): 109096 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/b320a70e-54f0-4628-89ba-4339e3fe1aad_20250124T14:55_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes ma'am, I'm calling about a claim for a patient.
[AGENT][NEUTRAL] OK, sure. I can assist you with claims. May I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And may I have a callback number just in case we get disconnected Miss [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 0 617357
[AGENT][POSITIVE] Mm thank you.
[AGENT][NEUTRAL] All this information.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And may I have the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Data service is [PII] and the bill amount is $358. It looks like it was partially paid.
[CUSTOMER][NEGATIVE] Let me see why the X-rays weren't paid.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] OK, let me pull the explanation of benefits, one moment.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Pa.
[AGENT][NEUTRAL] I'm still waiting on the document.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Then like I use it.
[AGENT][NEUTRAL] OK, so you're looking at the code um.
[AGENT][NEUTRAL] 274
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because I have it, you can have it every 6 months.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] And TAs aren't uh don't have a frequency.
[AGENT][NEUTRAL] Oh, OK. So it looks like the reason is because she still have that deductible. So, um, they were applied towards the calendar year deductible, the $50.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] That's fine. Um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hold on, I'm just looking at one thing real quick.
[AGENT][NEUTRAL] Mhm. Sure, yeah.
[CUSTOMER][POSITIVE] Yeah, I can on my friend.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, that looks like all um.
[CUSTOMER][NEUTRAL] So it's a fee schedule on this plan, is that correct?
[AGENT][NEUTRAL] Yes, this one pay a flat amount based on the codes.
[CUSTOMER][NEUTRAL] an amount based on the code, OK.
[AGENT][NEUTRAL] Yes, yeah, this one doesn't have percentage just like the rest. Mhm.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] So it looks, let me.
[CUSTOMER][NEUTRAL] So you'll pay for the exam.
[CUSTOMER][NEUTRAL] I'm just looking.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How much is the deductible?
[AGENT][NEUTRAL] $50.
[CUSTOMER][NEGATIVE] So what you were supposed to pay for the X-rays and exam is over $50. You're supposed to pay $35 for bite wings, $21 for the first PA, and $15 for the next PA. So that's over $50.
[AGENT][NEUTRAL] OK, based on the schedule of benefits on the coding for this group, for this type of plan, um, the, let's see, the 274 is paid at $20 220 dollars is paid at $10 and $230 is paid at $7.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then we have the pro fee which is paid at $40 and then the oral examination is paid at $15.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And again, this one has like flat amounts so it doesn't pay percentages like the other ones.
[CUSTOMER][NEUTRAL] OK, um, what is the reference number for the call?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you would like, Miss [PII]. Do you need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] And what is your name?
[AGENT][NEUTRAL] My name is [PII]. That's [PII]. Last initial is [PII].
[CUSTOMER][NEUTRAL] OK, and that is all I need.
[AGENT][POSITIVE] OK. Well, thank you for calling APL. You have a good day, Ms. [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Thank you.