AccountId: 011433970860
ContactId: c670735d-bc34-4ae5-90dc-5411f2a616d7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 290850 ms
Total Talk Time (AGENT): 110915 ms
Total Talk Time (CUSTOMER): 134797 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/c670735d-bc34-4ae5-90dc-5411f2a616d7_20250221T19:22_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, um, I just wanted to reach out. I'm calling from a provider, um, regarding a medical claim, and I wanted to see if you had received um a claim for a patient.
[AGENT][NEUTRAL] Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] Sure, my name is [PII]. Last initial [PII], um, direct line [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Can I have the member's policy number that you're calling to check the status of the claim?
[CUSTOMER][NEUTRAL] Sure, um, let me see here.
[CUSTOMER][NEUTRAL] So it's gonna be the group I have a group number and then I have an in hospitals benefit certification number and outpatient benefit certification number.
[AGENT][POSITIVE] Either one of the inpatient or outpatient number would be very helpful.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I'll give you the outpatient, so it's 022882868 M for Mike L8.
[AGENT][NEUTRAL] OK, give me that number again because I'm not sure if you was pausing after one of those 8 so.
[CUSTOMER][NEUTRAL] Sorry, sorry, no, it wasn't, it wasn't a AA, so it's 02282868 M L for Lima 8.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And [PII], what is this member's name and date of birth?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] It's gonna be [PII]. Date of birth [PII].
[AGENT][NEUTRAL] And you call and check the status of a claim for what date of service?
[CUSTOMER][NEUTRAL] Um, let me see here, so it's.
[CUSTOMER][NEUTRAL] Going to be.
[CUSTOMER][NEUTRAL] There's actually 2 days service, um, it's loading here, so the first is 114-24.
[CUSTOMER][NEUTRAL] Total bill amount 446.
[AGENT][NEUTRAL] One moment, I can only look at one at a time.
[AGENT][POSITIVE] So let me see if we have that one thank you.
[CUSTOMER][POSITIVE] No worries.
[AGENT][NEUTRAL] So we do with it with the procedure code of 92004.
[CUSTOMER][POSITIVE] That's correct, yep.
[AGENT][NEGATIVE] So we received the claim [PII]. It was processed [PII], and there was no payment due to the policy not covering office visits.
[CUSTOMER][NEUTRAL] OK, so the policy didn't cover.
[CUSTOMER][NEUTRAL] What um their primary uh didn't cover OK got you um.
[AGENT][NEUTRAL] If we don't cover office visits. It's um I can verify the benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I imagine that's gonna be the same case for the other data service as well, but we can we can try it.
[AGENT][NEUTRAL] So let me give you the claim number for this claim. Let me know when you're ready for it. It's 3.
[CUSTOMER][POSITIVE] Sure, uh huh, I'm ready when you are.
[AGENT][NEUTRAL] It's 353-133 um I'm giving too many numbers it's 353-1306.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So many 3s uh-huh uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, and then so that is going to be patient responsibility, OK, and the other data service is 11-824.
[AGENT][NEUTRAL] OK, it's the same thing.
[CUSTOMER][NEUTRAL] Uh, total bill amount and same thing, OK.
[AGENT][NEUTRAL] the
[CUSTOMER][NEUTRAL] All right. And what was your name, please?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK thank you.
[AGENT][NEUTRAL] And would you like that claim number?
[CUSTOMER][NEUTRAL] Um, yes, ma'am, whenever you're ready.
[AGENT][NEUTRAL] It is 353-8005.
[CUSTOMER][NEUTRAL] Uh huh uh huh.
[CUSTOMER][NEUTRAL] Got you, OK, and same situation, um.
[CUSTOMER][NEUTRAL] Doesn't cover office visits.
[AGENT][NEUTRAL] Offices they're not covered, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] Let me verify what it did cover when it was active.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So cover inpatient.
[AGENT][NEUTRAL] Outpatient per calendar the day outpatient benefits is $500.
[CUSTOMER][NEUTRAL] public life
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] And the treatment received in the office was covered under the policy.
[AGENT][NEUTRAL] No offices.
[AGENT][NEUTRAL] Yeah, the treatment received was covered under the policy. However, the office visits were not at the time that the policy was active.
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I don't think so. I really appreciate it. Thank you for your help.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL have a great day.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][POSITIVE] Thank you good bye.