AccountId: 011433970860
ContactId: ef588b24-4379-44d6-b893-9c14c8f30b49
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 339679 ms
Total Talk Time (AGENT): 80954 ms
Total Talk Time (CUSTOMER): 115533 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/ef588b24-4379-44d6-b893-9c14c8f30b49_20250226T20:20_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey, [PII]. I've got a provider on the back line that is wanting to check the claim status on an insured's policy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's 1749775, Mark, right?
[CUSTOMER][NEUTRAL] Is the insured. [PII] is the provider. She said the claims were from [PII], but she's got a couple of them, she said.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Do you have her callback number?
[CUSTOMER][NEUTRAL] [PII] and everything's been verified.
[AGENT][POSITIVE] All righty. Thank you.
[CUSTOMER][POSITIVE] All right, here she goes. Thank you, hon. Have a good day.
[AGENT][NEUTRAL] You too. Bye-bye. This is [PII], may I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII]. I'm calling from Medical Associates Clinic.
[CUSTOMER][NEUTRAL] And it looks like [PII] transferred me to you. I was checking the status on the claim.
[AGENT][NEUTRAL] OK. Yes, ma'am. She gave me the information. Um, what date of service was it for?
[CUSTOMER][NEUTRAL] It's for [PII]. The billed amount was $318.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Was it for facility bill or doctor's charge?
[CUSTOMER][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Or do you have a procedure code?
[CUSTOMER][NEUTRAL] I do. I have like the.
[CUSTOMER][NEUTRAL] Diagnosis, I think it is. I have, there's two parts of it. One is 99232.
[CUSTOMER][NEUTRAL] And that one was $162 or $61 161 dollars, and the other one was 93306P.
[CUSTOMER][NEUTRAL] And that was $157.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And that was for 124, 24.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Hold on one moment, we got 2 claims with the same.
[AGENT][NEUTRAL] What doctor is it with?
[CUSTOMER][NEUTRAL] I'm Doctor [PII], um, from the bad again. I can spell his name. He's a doctor at the cardiology.
[AGENT][NEGATIVE] Oh no.
[AGENT][NEUTRAL] Hold on just a second, let me see if this is.
[AGENT][NEUTRAL] Is it Grand River Medical Group?
[AGENT][NEUTRAL] Or
[CUSTOMER][NEUTRAL] Yeah, he's from [PII]. He saw him at Finley Hospital.
[AGENT][NEUTRAL] Let's see if this one did.
[AGENT][NEUTRAL] OK. What was the doctor's name?
[CUSTOMER][NEUTRAL] Um it's spelled, the last name is spelled [PII]
[AGENT][NEUTRAL] OK, so this one's not it. Hold on one moment.
[AGENT][NEUTRAL] OK, the explanation of benefits that we got.
[AGENT][NEGATIVE] Does not show anything was applied to their deductible or co-pay or co-insurance.
[AGENT][NEGATIVE] Looks like it was paid in full, so it was denied as major medical paid in full.
[CUSTOMER][NEUTRAL] Could I get a copy of that explanation of benefits?
[AGENT][NEUTRAL] Yes, ma'am. I can fax it to you. What's your fax number?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, I'll fax that to you.
[CUSTOMER][NEUTRAL] Can you write attention, [PII] on that?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And do you have a call reference number too?
[AGENT][NEUTRAL] We do not have call reference numbers. You can use my name in today's date.
[CUSTOMER][NEUTRAL] And you're [PII], right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Thank you so much. You have a great day.
[AGENT][POSITIVE] Thank you, [PII], for calling APLU as well.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Bye bye.