AccountId: 011433970860
ContactId: da5dac7a-887a-429b-862c-a3e33f8557fb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 370230 ms
Total Talk Time (AGENT): 125440 ms
Total Talk Time (CUSTOMER): 123228 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/da5dac7a-887a-429b-862c-a3e33f8557fb_20250312T18:40_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Uh, yes, um, I was trying to get um some information about a claim.
[AGENT][NEUTRAL] OK, I can verify the claim status for you and your name is?
[CUSTOMER][NEUTRAL] Uh, my name is [PII]
[AGENT][NEUTRAL] OK, and Ms. [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] It's 02506721.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, thank you. And Ms. [PII], verify the patient's name, date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and it's [PII].
[AGENT][NEUTRAL] OK, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes ma'am, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And what was the date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] It's [PII] and it's $383.
[AGENT][NEUTRAL] OK, thank you, ma'am. Give me one moment, please.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And you're calling from?
[CUSTOMER][NEUTRAL] South View Medical Group.
[AGENT][NEUTRAL] Uh, give me one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Why my my computer is running slow.
[CUSTOMER][POSITIVE] Yeah, you're welcome.
[AGENT][NEUTRAL] Was there, were there two claims that were sent?
[CUSTOMER][NEUTRAL] Uh, I'm only showing one. It may have split though, um, because that's why I was calling because I think it was the last 6, of the CPT codes. They was not on the remit that was sent in.
[CUSTOMER][NEUTRAL] So it's possible it could have split.
[AGENT][NEUTRAL] Uh, are you showing those codes is [PII] and 86703?
[CUSTOMER][NEUTRAL] Um, those were the codes I was gonna ask if they had been processed. Um, they were not on the remit that, uh, we had received back with payment.
[AGENT][POSITIVE] OK, I got you.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] Yeah, it looks like it was split, um.
[AGENT][NEUTRAL] Because one claim, it looks like we paid on and that total was $270 this other one was $113.
[AGENT][NEUTRAL] And on this, on this claim with those 6 codes.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh let's see.
[AGENT][NEUTRAL] It looks like it processed the maximum benefit for the data service has been met.
[AGENT][NEUTRAL] And yeah, it looks like um they met their benefit max for the year.
[CUSTOMER][NEUTRAL] OK, so would that be, would it all be billable to the patient?
[AGENT][NEUTRAL] Well, we can't get patient responsibility. Uh, we can only verify it's processed, but
[AGENT][NEUTRAL] I can say more unlikely.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, because the only reason I'm calling is because the um the first. What is that 123456. The 1st 6 CPT codes um like there wasn't any adjustments or anything it just basically said what they um what what you guys have paid um and I did not want to go the patient for more, you know, than they um would have owed, but they're not being any adjustments on the remit, you know, I'm kinda like well I bill I bill it all to them.
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] Well, we don't make adjustments. Uh, with this type of policy, they have a limited medical indemnity plan. So it just pays, uh, benefit according to the policy. There's no right, um, it doesn't reprice any claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it's just limited benefit. OK, um, and does it tell you when the last 6 CBT cos processed or no?
[AGENT][NEUTRAL] Um, the Lasix that processed on.
[AGENT][NEUTRAL] The 5th.
[CUSTOMER][NEUTRAL] OK, so we should be OK.
[AGENT][NEUTRAL] Of March. I'm sorry.
[CUSTOMER][NEUTRAL] No, that is OK.
[CUSTOMER][NEGATIVE] OK, well, I guess that's all I needed to know was they just have limited benefits. I just didn't wanna be them and them calling, um, not be too happy with me.
[AGENT][NEUTRAL] Oh no, I understand. Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh, and can I get your name again and a call reference number?
[AGENT][NEUTRAL] Uh, my name is [PII], last initial [PII].
[CUSTOMER][NEUTRAL] OK, and the reference number.
[AGENT][NEUTRAL] Uh, we don't give reference numbers, but you may use my name in today's date if you like.
[CUSTOMER][POSITIVE] OK, I will do it thank you so much.
[AGENT][POSITIVE] Alright, you're welcome. Thanks for calling APM Ms. [PII]. Have a great day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Yeah