AccountId: 011433970860
ContactId: e3845cf4-e28c-41b5-95c8-bc306c00dc00
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 274440 ms
Total Talk Time (AGENT): 97822 ms
Total Talk Time (CUSTOMER): 63555 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/e3845cf4-e28c-41b5-95c8-bc306c00dc00_20250311T15:41_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII]. I'm calling for the provider Emory Clinic. I was calling to get status on a medical claim, please.
[AGENT][POSITIVE] All right, well, I'll be more than happy to help you with the claim status and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] That is [PII], no [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] They have here 022 06104 [PII].
[AGENT][NEUTRAL] Hold on one moment. OK, can you verify the member's date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And may I have the date of service for the claim you like me to check on?
[CUSTOMER][NEUTRAL] Data services [PII] for $2013 even.
[AGENT][NEUTRAL] And this is for [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] I can, you said it's Emry Clinic?
[CUSTOMER][NEUTRAL] Um, yes, Emory clinic.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You want the tax ID?
[AGENT][NEUTRAL] Um, no, it's OK. 6.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me make sure I do that. Hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Alright, so I'm showing received the claim on [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claim number is 356-4057.
[AGENT][NEUTRAL] And on [PII], the claim was denied, and I'm getting that reason for you now.
[CUSTOMER][POSITIVE] Mhm. Thank you.
[AGENT][NEUTRAL] You're welcome. The benefit maximum for this data service has been met.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Same patient, same date of service.
[CUSTOMER][NEUTRAL] For $702.
[CUSTOMER][NEUTRAL] For Doctor [PII]
[AGENT][NEUTRAL] OK, so we received that one twice. Hold on one moment.
[CUSTOMER][NEUTRAL] Well, it's gonna be for two different providers that's why it's for the anesthesiology charges.
[AGENT][NEUTRAL] You need both of them?
[CUSTOMER][NEUTRAL] Yeah, one's gonna be for Doctor [PII] and the other one's gonna be for Doctor [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 33 and
[AGENT][NEUTRAL] 33 and 35, OK.
[AGENT][NEUTRAL] OK, so both claims were received on [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, I can't tell which one is which. They both say the Emory Clinic.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So I'll say the one with procedure code 88305.
[AGENT][NEGATIVE] Was denied hold on.
[AGENT][NEUTRAL] It's not a covered loss under the plan, therefore, no amount payable.
[AGENT][NEUTRAL] There's no amount payable for this expense, so it's not a covered charge.
[AGENT][NEUTRAL] Or code