AccountId: 011433970860
ContactId: be2abaa7-fcf5-459c-9edf-2d435d2f6047
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 494920 ms
Total Talk Time (AGENT): 123024 ms
Total Talk Time (CUSTOMER): 163403 ms
Interruptions: 3
Overall Sentiment: AGENT=1.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/be2abaa7-fcf5-459c-9edf-2d435d2f6047_20250414T16:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, um, good afternoon, [PII]. My name is [PII] calling from Gissinger Clinic. And I'm sorry, what was your name again?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] Hello. Oh, that's right. Thank you. I'm so sorry.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Like doing multiple things. Uh, yes, I'm calling from pricing our clinic checking on claim status.
[AGENT][NEUTRAL] OK, and did you say your first name is [PII]?
[CUSTOMER][NEUTRAL] That's right, [PII]
[AGENT][POSITIVE] Thank
[AGENT][POSITIVE] Thank you and what is your callback number as well please? Thank you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you [PII]. What is the policy number please?
[CUSTOMER][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] 02581811
[AGENT][POSITIVE] OK, I have that as 02581811. Thank you.
[AGENT][NEUTRAL] And verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, um, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you very much and you're calling for claim status. I can assist you with that, [PII]. What is the date of service and the total charge amount?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 927 2024 for $455.
[AGENT][NEUTRAL] It's $155 OK.
[CUSTOMER][NEUTRAL] And we have
[CUSTOMER][NEUTRAL] Yeah, we have this uh secondary.
[AGENT][NEUTRAL] OK, one moment please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] $455.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Are there 1 or 2 procedure codes built for the service state for the member.
[CUSTOMER][NEUTRAL] Yeah, let me check that for you. We build a 99215 and the G2211.
[AGENT][NEUTRAL] OK, and the total charge on that on that sorry claim again is $455 or.
[CUSTOMER][POSITIVE] Well, actually I, I, I'm so sorry. The total is 497. I'm so sorry.
[AGENT][NEUTRAL] Is it a different amount?
[CUSTOMER][NEUTRAL] I was just looking at the online.
[CUSTOMER][NEUTRAL] The world's first.
[AGENT][NEUTRAL] 497. OK, give me one moment.
[CUSTOMER][POSITIVE] That's. Take your time.
[AGENT][NEUTRAL] I'm gonna place you on a brief hold please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure, that's fine.
[AGENT][POSITIVE] Thank you so much for your patience with me, [PII].
[AGENT][NEUTRAL] The claim, thank you. The claim was received and for procedure code 99215, it denied as office visits are not covered and for G2211 that denied as it shows that the major medical did not apply any charges towards the deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Major medical did not apply any charges. OK. And um what is the claim number?
[AGENT][NEUTRAL] 356-9886
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So CPT code 992 end.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What is um patient responsibility?
[AGENT][NEUTRAL] Um, APL does not determine the patient's responsibility.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK. Um, is there any way you could send me a copy of the explanation of payment, please?
[AGENT][NEUTRAL] Um, actually you're able to get that copy on the website at [PII] and you can also check claim status, but I will get that sent over for you today. What is that fax number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That'll be great. Can you email it to me, ma'am?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Do you have a fax number or just the email?
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] Yeah, but I would prefer an email, please.
[CUSTOMER][NEUTRAL] It would come directly to me and then I could apply that.
[AGENT][NEUTRAL] What is the email address?
[CUSTOMER][NEUTRAL] Can I give that to you?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, that is [PII].
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now, is there any way I can get um a reference number, please?
[AGENT][NEUTRAL] Uh, no, we do not provide reference numbers. You can use my name and today's date. The last initials [PII] like [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that'll be great.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, 14. Yeah, thank you very much. I really appreciate your help.
[AGENT][POSITIVE] You're welcome, [PII], and thank you for calling APL. Have a good day. Take care bye.
[CUSTOMER][POSITIVE] You too. Thank you.