AccountId: 011433970860
ContactId: bade1b37-5ee3-4ee8-997e-671fda730948
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 310959 ms
Total Talk Time (AGENT): 109658 ms
Total Talk Time (CUSTOMER): 120510 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/2025/02/07/bade1b37-5ee3-4ee8-997e-671fda730948_20250207T19:37_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling for provider to check on additional information about your claim that has been denied. Please note this call will be monitored and recorded for quality and training purpose. Before proceeding with the call, will you please spell your name for me?
[AGENT][NEUTRAL] Sure. [PII]. And [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Policy number is?
[CUSTOMER][NEUTRAL] 02440960.
[AGENT][NEUTRAL] Thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah, callback number is [PII]. It's a direct line.
[AGENT][NEUTRAL] OK, thank you. And Ms. [PII], verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. And you say you're calling to verify claim status, is that correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] The service is uh [PII]. The amount is $416 even 416. This claim.
[CUSTOMER][NEUTRAL] rejected, uh, with the reason, you know with the reason, we are awaiting information to confirm eligibility from benefits.
[AGENT][NEUTRAL] OK. And you're calling from?
[CUSTOMER][NEUTRAL] Provider's office name is Previa Medical Group of Georgia LLC.
[AGENT][NEUTRAL] OK, thank you. And you said the date of service was [PII] or [PII], I'm sorry.
[CUSTOMER][NEUTRAL] Yeah, bill amount 416.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm showing on this claim, it looks like we paid $150 and this was processed on, give me one moment.
[AGENT][NEUTRAL] Uh, looks like the claim was processed.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] And the check has been mailed any amount of 150.
[CUSTOMER][NEUTRAL] Just a moment. Initially, it was uh reed. If it reprocessed, will you please provide me the claim reprocessed date and claim number?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] As I say, the claim process on [PII], claim number 3552215.
[CUSTOMER][NEUTRAL] Allowed and paid amount, please.
[AGENT][NEUTRAL] Uh, it paid $150.
[CUSTOMER][NEUTRAL] Is it also allowed the same?
[AGENT][NEUTRAL] It's not allowed amount. It's just per the policy, that's the max benefit payable for that date.
[CUSTOMER][NEUTRAL] OK, I'll lot amount on this claim, please.
[AGENT][NEUTRAL] There is not a lot amount, that's just an amount that's payable and per this policy for an office visit, the max payable is 150 and that's how much we paid.
[AGENT][NEUTRAL] We don't have an allowed amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Uh, it was paid via check or EFT?
[AGENT][NEUTRAL] Uh, paper check.
[CUSTOMER][NEUTRAL] Check number, please.
[AGENT][NEUTRAL] 202-5334.
[CUSTOMER][NEUTRAL] When it was issued.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. It's a single or bulk payment?
[AGENT][NEUTRAL] Single
[CUSTOMER][NEUTRAL] OK. When it was cashed?
[AGENT][NEUTRAL] Uh, let me see if it shows that give me one moment.
[AGENT][POSITIVE] I don't show that it cleared. It's still showing uh outstanding.
[CUSTOMER][NEUTRAL] OK. Uh, is the patient account number [PII] [PII]?
[AGENT][NEUTRAL] Uh, that's what I'm showing that we have, yes, ma'am.
[CUSTOMER][NEUTRAL] OK. Is the payment uh payment center address [PII]
[CUSTOMER][NEUTRAL] 4047
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, thank you. I got all the details and it was issued recently on [PII]. It was not yet casted. Will you please provide me the call reference number please?
[AGENT][NEUTRAL] Oh, we don't give reference numbers. If you like, you may use my name at today's date. Mm.
[CUSTOMER][POSITIVE] Thank you. Thanks for your assistance. Have a great day, bye.
[AGENT][POSITIVE] Alright, you're welcome, Ms. [PII], and thank you for calling APL. Bye.