AccountId: 011433970860
ContactId: b77977c1-cc57-4907-a154-fce2cf57f26e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 323100 ms
Total Talk Time (AGENT): 55715 ms
Total Talk Time (CUSTOMER): 90497 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/b77977c1-cc57-4907-a154-fce2cf57f26e_20250603T17:00_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and my last name's initial is [PII], calling on behalf of the provider's office to check on a claim status. Could you please spell your name and also can I have your last name's initial?
[AGENT][NEUTRAL] Sure, it's [PII], last initial [PII]
[AGENT][NEUTRAL] And Miss [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] That is 1066765.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII], it's a direct line.
[AGENT][NEUTRAL] OK, thank you. And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Member's name is uh
[CUSTOMER][NEUTRAL] No, [PII].
[CUSTOMER][NEUTRAL] [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] OK, thank you. And what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] Day of service is on [PII] for the amount of $1,222 even.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, and what was the balance after primary?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So, the coincidence amount which was allowed by the primary is $147.85.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, and you're calling from?
[CUSTOMER][NEUTRAL] [PII] has corp of INC.
[AGENT][NEUTRAL] And what was the procedure code?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] It's for the code 00840.
[AGENT][NEUTRAL] And what's the modifier?
[CUSTOMER][NEUTRAL] Modify.
[CUSTOMER][NEUTRAL] QXP 2.
[AGENT][NEUTRAL] OK. I'm showing that claim process as the benefits of Max for the data service.
[CUSTOMER][NEUTRAL] OK. Hold on just for a minute.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm sorry, hold on.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] What is the uh
[CUSTOMER][NEUTRAL] Is it um
[CUSTOMER][NEUTRAL] Reached
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] In terms of dollar or visits?
[AGENT][NEUTRAL] In terms of dollars.
[CUSTOMER][NEUTRAL] Uh, how much dollar amount is allowed?
[AGENT][NEUTRAL] Well, the patients have an outpatient benefit that pays up to $500 per calendar day.
[CUSTOMER][NEUTRAL] How much dollar amount does the patient has been met excluding this claim?
[AGENT][NEUTRAL] $500 for the date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Can I get the call reference number?
[AGENT][NEUTRAL] You may use my name in today's date if you like.
[CUSTOMER][POSITIVE] Yeah, thank you, [PII], for your assistance. That's all from my end. Bye for now.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh, you're welcome. Thanks for calling APL bye.
[CUSTOMER][NEUTRAL] Mm.