AccountId: 011433970860
ContactId: ece6486f-58fa-4f5b-b9d9-e2ce414f3968
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 326109 ms
Total Talk Time (AGENT): 87055 ms
Total Talk Time (CUSTOMER): 118829 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/ece6486f-58fa-4f5b-b9d9-e2ce414f3968_20250617T15:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, definitely. My name is [PII] calling from provider's office to check on a claim status.
[AGENT][NEUTRAL] OK, [PII], I can help you with claim status. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, uh, the callback number is [PII], and this call is getting recorded. So are you OK with this, [PII]?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And you have the policy number for the patient?
[CUSTOMER][NEUTRAL] Yes, 024.
[CUSTOMER][NEUTRAL] 80051 M as in Murphy L as in Lima 7.
[AGENT][NEUTRAL] Uh, patient name and date of birth.
[CUSTOMER][NEUTRAL] Patient's name is [PII] and date of birth [PII].
[AGENT][NEUTRAL] And date of service and bill charges.
[CUSTOMER][NEUTRAL] Date of service is [PII] and the charge amount is $621 even.
[AGENT][NEUTRAL] Uh, looks like we received the claim 3-17-2025.
[AGENT][NEUTRAL] Also 320, 2025.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, offices that are not covered under the policy.
[AGENT][NEUTRAL] And then it looks like the rest of the charges primary paid in full, so no benefits are payable.
[CUSTOMER][NEUTRAL] So it's a primary paid more than secondary allowable amount or the services does not covered under member's policy?
[AGENT][NEUTRAL] The first line item, the 99213, that's not covered under the policy.
[AGENT][NEUTRAL] The rest of the charges, the primary paid in full, so there's nothing left to pay.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, and uh may I know the allowed amount for the rest of the security code?
[AGENT][NEUTRAL] Or which CPT code?
[CUSTOMER][NEUTRAL] For a lab coat.
[AGENT][NEUTRAL] There is no allowed
[CUSTOMER][NEUTRAL] 87426 and it's.
[AGENT][NEUTRAL] There's no allowed amount primary paid in full, so we, we don't pay anything.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEGATIVE] They paid 100%, so we didn't pay anything.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes and um.
[CUSTOMER][NEUTRAL] Can I get the claim number for this?
[AGENT][NEUTRAL] 357-843-6.
[CUSTOMER][NEUTRAL] And the call reference number be the same for the entire call different as for the patient wise.
[AGENT][NEUTRAL] The call reference is my name is [PII] and today's date.
[CUSTOMER][NEUTRAL] Uh, OK. And I have one more claim. Can you please help me out with that also?
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The policy number for the patient?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] The member's policy is policy number is 025.
[CUSTOMER][NEUTRAL] 17188 M as in Murphy, L as in Lima 8.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Date of service and bill charges.
[CUSTOMER][NEUTRAL] Date of service is [PII] and the charge amount is $621 even.
[AGENT][NEUTRAL] It was received on [PII], process [PII].
[AGENT][NEUTRAL] Office visits are not covered under the policy?
[AGENT][NEUTRAL] And the rest of the charges were paid in full by primary, so nothing's left to pay.
[CUSTOMER][NEUTRAL] OK, so this is non good as per patient plan, right?
[AGENT][POSITIVE] Correct, for the office visit, yes.
[CUSTOMER][NEUTRAL] And uh may I know the patient plan name?
[AGENT][NEUTRAL] A link
[CUSTOMER][NEUTRAL] No, for the American public life insurance, insurance, the patient plan name.
[AGENT][NEUTRAL] The plan name is Medlink M E D L I N K.
[CUSTOMER][NEUTRAL] OK. And can I get the claim number?
[AGENT][NEUTRAL] 356-4058.
[CUSTOMER][POSITIVE] Uh, OK, so [PII], yes, that's it from my side. Thank you for assisting me.
[CUSTOMER][POSITIVE] Have a great day.
[AGENT][POSITIVE] Thank you. Thanks for calling APL. You too. Bye bye.