AccountId: 011433970860
ContactId: c31c4f8c-b07c-4b50-b3d9-7e39a067bfa7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 721679 ms
Total Talk Time (AGENT): 198766 ms
Total Talk Time (CUSTOMER): 257099 ms
Interruptions: 5
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/c31c4f8c-b07c-4b50-b3d9-7e39a067bfa7_20250103T16:51_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling EPO. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] know
[CUSTOMER][NEUTRAL] Uh, hello, good morning. It's [PII] calling from provider's office to check on the claim status.
[AGENT][NEUTRAL] OK, sure. I can assist you with claim status, Mr. [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] OK uh so.
[CUSTOMER][NEUTRAL] Yeah, sure. The callback number would be [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, yeah, sure. Uh, just before that, could you please uh spell your name?
[AGENT][NEUTRAL] Sure, that's [PII].
[CUSTOMER][NEUTRAL] OK, thank you. And uh provider insurance number would be 01070755.
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] It's for [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, what's her date of birth?
[CUSTOMER][NEUTRAL] The date of birth would be [PII].
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK. And what's the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] Um, the date of service was of [PII] for the total charge amount of $535 even.
[AGENT][NEUTRAL] [PII], the amount of 535.
[CUSTOMER][POSITIVE] The good thing about these ones that is that.
[CUSTOMER][POSITIVE] Yeah, that's correct.
[AGENT][NEUTRAL] OK, let me see if I can find this claim and for future you can share claim status online through our website at [PII] and that's just optional. And bear with me, let me see if this is your claim. One moment.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Just checking if you have.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] What's your name?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm still waiting on the ear.
[CUSTOMER][POSITIVE] So, so no worries, yeah.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] I'm still waiting on the explanation of benefits to pull up. One moment.
[CUSTOMER][POSITIVE] And oh, OK, take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I have the.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEGATIVE] No, no.
[CUSTOMER][NEUTRAL] OK, so could you help me with your.
[AGENT][NEUTRAL] OK, the amount you provided to me was 535.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. All right. OK, it looks like we processed the claim on [PII] and we send a benefit amount of $25 to the provider.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] $25 even.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and uh was that the patient responsibility for allowed amount or?
[AGENT][NEUTRAL] We're not the major medical, um, so the other two, the codes, um, one of them was denied, which it was the code 1005 was denied stating that the maximum benefit for the office visit has been exhausted, and for that $25 which it was applied towards the 99214, that is the maximum benefit. $25 is the maximum benefit.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, so there is no patient responsibility, right?
[AGENT][NEGATIVE] Not with us.
[CUSTOMER][NEUTRAL] OK. And uh could you please uh help me with the payment details like check number, check it, clear it.
[AGENT][NEUTRAL] Mhm. Yeah, sure. Um, OK, we have, um, this is a single check, paper check. The check number is 1840068.
[AGENT][NEUTRAL] Let me see if I can find a clear date. One moment. The issue date is the same one as the process date, which it was [PII].
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK. And this uh check cleared on [PII].
[CUSTOMER][NEUTRAL] 1
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh, on April.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. And uh could you also please help me out with the claim number?
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yes, the claim number is 342-8001.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You should
[CUSTOMER][NEUTRAL] OK, it's 342-800-01. Is that correct?
[AGENT][POSITIVE] Mhm, that is correct.
[CUSTOMER][NEUTRAL] OK, and uh I just wanted to let you know like I have 2 more members so can you please help me out with that?
[AGENT][NEUTRAL] OK. I'll have to make a note on each one before I move forward, OK? So let me go ahead and complete the note on this one. And you don't need any other information on this one?
[CUSTOMER][NEUTRAL] Yeah. Yeah.
[CUSTOMER][NEUTRAL] Uh, no, that's it.
[AGENT][NEUTRAL] OK, alright, so let me make the note one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh I just wanted to ask like, uh, please to call that some of the team for the whole call or different for the member.
[AGENT][NEUTRAL] Um, we don't have reference numbers. It's my name in today's date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what's the next policy number?
[CUSTOMER][NEUTRAL] OK, so the next one is come over today.
[CUSTOMER][NEUTRAL] 01982130 M as in Mary L as in Lima 8.
[AGENT][NEUTRAL] What's the name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The date of service was [PII].
[CUSTOMER][NEUTRAL] [PII] for the total charge amount of $225 even.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the [PII], correct?
[CUSTOMER][NEUTRAL] [PII] years. That's correct.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I don't have that claim on file.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so we'll move forward to the next number.
[AGENT][NEUTRAL] OK, let me make a note on this one.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, what is the next policy number?
[CUSTOMER][NEUTRAL] It's 02369683 M as in Mary, L as in Lima and then number 8.
[AGENT][NEUTRAL] OK, what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Alright, thank you.
[AGENT][NEUTRAL] OK, and what is the date of service and the amount of the claim?
[CUSTOMER][NEUTRAL] The dealer service is [PII] and it was charged for $325 each.
[AGENT][NEUTRAL] OK, [PII] for 325.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't have a claim for [PII] for this number.
[AGENT][NEUTRAL] Is it [PII] or [PII]?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Um, no, it's for [PII].
[AGENT][NEUTRAL] No. OK, yeah, we don't have a claim for that day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that's fine. Uh, that's it for the day. Thank you so much sir for your assistance, and I hope you have a wonderful, great day.
[AGENT][POSITIVE] You as well thank you for calling APM.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Right.