AccountId: 011433970860
ContactId: ca392b8d-15e2-410e-9e48-d495a941af78
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 952500 ms
Total Talk Time (AGENT): 156500 ms
Total Talk Time (CUSTOMER): 170209 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=-1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/ca392b8d-15e2-410e-9e48-d495a941af78_20250127T15:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I need to check on the claim status for the number.
[AGENT][NEUTRAL] I'm sure, [PII] I can assist you with client status. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] It's 0251237777.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] The patient's name is [PII].
[CUSTOMER][NEUTRAL] OK, [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. Now I need the date of service and bill charges for the claim you're calling about.
[CUSTOMER][NEUTRAL] Yeah, the details so this is [PII] for the total charges of 4 $546 even.
[AGENT][NEUTRAL] OK, one moment. I'm waiting on my system.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, yes, so we received that claim on, let's see, we received the claim on [PII].
[AGENT][NEUTRAL] The claim processed on [PII].
[AGENT][NEUTRAL] The claim number is 3536649.
[AGENT][NEUTRAL] And this claim denied because office visit benefit maximum was reached for the calendar year.
[CUSTOMER][NEUTRAL] OK, may I know how many offices it to the number?
[AGENT][NEUTRAL] 4
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] When was the last movie was met?
[AGENT][NEUTRAL] One moment, let me get that for you.
[CUSTOMER][NEUTRAL] yeah
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] One moment, I'm still waiting on my system.
[CUSTOMER][POSITIVE] Yeah, no problem. Take your time.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK, that was reached on [PII].
[CUSTOMER][NEUTRAL] OK, last visit on [PII], right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the last visit was [PII] and the claim was and the date of service was [PII]. So it is within the
[AGENT][NEUTRAL] Yes, we go by, we go by when we received the claim. We received that claim before we received um your claim. So that's why I paid first.
[CUSTOMER][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] So the member is responsible for the payment.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] So, for this, we need PRUB. So could you please provide us the PRUB through fax?
[AGENT][NEUTRAL] Yes, what's your fax number, please?
[CUSTOMER][NEUTRAL] Yes, one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, fax number is [PII].
[AGENT][NEUTRAL] So that's [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, 9 to 54, yeah.
[AGENT][NEUTRAL] And who would I attention it to? Would I attention it to you?
[CUSTOMER][NEUTRAL] No, it's not on Community Medical Associates.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sorry, who do I attention it to?
[CUSTOMER][NEUTRAL] Norton Community Medical Associates.
[AGENT][POSITIVE] OK. I just sent it. You should receive it in about 10 minutes. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Yeah, there is another claim and it's for the different member. So could you please assist me with that?
[AGENT][NEUTRAL] Um, yes, one moment, please.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm gonna place you on a brief hold. One moment.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, [PII], thanks for your patience. I'm ready for the next policy number.
[CUSTOMER][NEUTRAL] OK. The next policy number is 02544684.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] The date of service and bill charges on the claim, please.
[CUSTOMER][NEUTRAL] Yeah, the date of service is number [PII] of 2024 for the total charges of $26 even.
[AGENT][NEUTRAL] I'm sorry. What's the month and the day?
[CUSTOMER][NEUTRAL] It's number 8 of 2024 for the total charges of $26 even.
[AGENT][NEUTRAL] OK, [PII]. OK, one moment.
[AGENT][NEUTRAL] OK, I'm not showing a claim on file for [PII] for $26 even.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Can I provide you the claim number?
[AGENT][NEUTRAL] Yes, what's the claim number?
[CUSTOMER][NEUTRAL] It's 352 9.
[CUSTOMER][NEUTRAL] 589.
[AGENT][NEUTRAL] OK, I found the claim. Um, yes, I'm showing that this claim is denying because veal punctures are not covered under the policy. Do you need a copy of this EOB also?
[CUSTOMER][NEUTRAL] Uh, could you please tell me again, uh,
[AGENT][NEGATIVE] Vena punctures, which is what was, was billed on the claim, it's not covered under the policy.
[CUSTOMER][NEUTRAL] So the CPT does not cover under the member's policy, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, so the member is responsible for the payment.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. For the CBT 36415, what is going to be the loan amount?
[AGENT][NEUTRAL] There is no allowed amount.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Because it's not covered under the policy.
[CUSTOMER][NEGATIVE] No allowed on.
[CUSTOMER][NEUTRAL] OK, one moment. One moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] May I know the total bill amount of $26 is going to be the patient responsibility, right?
[AGENT][NEUTRAL] Yes, it is.
[AGENT][NEUTRAL] Do you need a copy of this EOB also?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No, no, no, uh, could you please find me the reference number for this?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name in today's day. Again, it's Evie spelled [PII], last initial [PII], and today's date.
[CUSTOMER][POSITIVE] OK, thank you for assisting me today. Have a nice day.
[AGENT][NEUTRAL] OK,